Provider Demographics
NPI:1992465868
Name:ALASKA MIGRAINE SPECIALISTS, LLC
Entity type:Organization
Organization Name:ALASKA MIGRAINE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-331-9835
Mailing Address - Street 1:PO BOX 670601
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-0601
Mailing Address - Country:US
Mailing Address - Phone:907-331-9835
Mailing Address - Fax:
Practice Address - Street 1:13135 OLD GLENN HWY STE 100
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7584
Practice Address - Country:US
Practice Address - Phone:907-331-9835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK2123184OtherBUSINESS LICENSE