Provider Demographics
NPI:1982047437
Name:ALASKA TRAUMA & ACUTE CARE SURGERY, LLC
Entity type:Organization
Organization Name:ALASKA TRAUMA & ACUTE CARE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDERELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLLEFSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-375-8785
Mailing Address - Street 1:PO BOX 200667
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99520-0667
Mailing Address - Country:US
Mailing Address - Phone:907-375-8785
Mailing Address - Fax:907-375-8788
Practice Address - Street 1:3220 PROVIDENCE DR
Practice Address - Street 2:SUITE E3 040
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4679
Practice Address - Country:US
Practice Address - Phone:907-375-8785
Practice Address - Fax:907-375-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK984564208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty