Provider Demographics
NPI:1366580912
Name:ALASKA INTERNAL MEDICINE & PEDIATRICS LLC
Entity type:Organization
Organization Name:ALASKA INTERNAL MEDICINE & PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:O'FALLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-770-7800
Mailing Address - Street 1:4048 LAUREL ST STE 306
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5391
Mailing Address - Country:US
Mailing Address - Phone:907-770-7800
Mailing Address - Fax:907-929-4660
Practice Address - Street 1:4048 LAUREL ST STE 306
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5391
Practice Address - Country:US
Practice Address - Phone:907-770-7800
Practice Address - Fax:907-929-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA3566174400000X
AK2342174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1902877251OtherO'FALLON (NPI)
AKMD2282Medicaid
AKMD7864Medicaid
AK1710958061OtherMONTANO (NPI)
AKG06741Medicare UPIN
AKH63242Medicare UPIN
AKK152174Medicare ID - Type UnspecifiedMONTANO MD, LAURIE
AKK152146Medicare ID - Type UnspecifiedO'FALLON MD, MICHELE
AKK152147Medicare ID - Type UnspecifiedAK INTERNAL MEDICINE & PE