Provider Demographics
NPI:1609176783
Name:ALGONE CENTER
Entity type:Organization
Organization Name:ALGONE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GRISSOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-373-9460
Mailing Address - Street 1:PO BOX 870904
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-0904
Mailing Address - Country:US
Mailing Address - Phone:907-373-9460
Mailing Address - Fax:907-373-9461
Practice Address - Street 1:3066 E MERIDIAN PARK LOOP
Practice Address - Street 2:#1
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7299
Practice Address - Country:US
Practice Address - Phone:907-373-9460
Practice Address - Fax:907-373-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-23
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty