Provider Demographics
NPI:1295305514
Name:INNOVATIVE NEUROSURGERY ASSOCIATES, LLC
Entity type:Organization
Organization Name:INNOVATIVE NEUROSURGERY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-243-0339
Mailing Address - Street 1:P.O. BOX 110909
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0909
Mailing Address - Country:US
Mailing Address - Phone:907-243-0339
Mailing Address - Fax:907-243-0337
Practice Address - Street 1:1200 AIRPORT HEIGHTS DRIVE
Practice Address - Street 2:SUITE E-355
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-243-0339
Practice Address - Fax:907-243-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty