Provider Demographics
NPI:1871754473
Name:LIFEMED ALASKA, LLC
Entity type:Organization
Organization Name:LIFEMED ALASKA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-249-8451
Mailing Address - Street 1:6320 S AIRPARK PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-1865
Mailing Address - Country:US
Mailing Address - Phone:907-563-6633
Mailing Address - Fax:907-563-6636
Practice Address - Street 1:6320 S AIRPARK PL
Practice Address - Street 2:HANGAR #1 AND #2
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-1865
Practice Address - Country:US
Practice Address - Phone:907-563-6633
Practice Address - Fax:907-563-6636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4300341600000X, 3416A0800X
341600000X
AK9150563416A0800X
AK63003416A0800X
AK93003416A0800X
AK33003416L0300X
AK32003416L0300X
AK33053416L0300X
AK32203416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC8626Medicaid
K165057OtherPTAN
AKAA6300Medicaid
AKTX6224Medicaid
AKGA6320Medicaid
K161982OtherPTAN