Organization · NPI-2

Jessica Spayd

· Eagle River, AK

NPI number1255465720
StatusActive
Last updated in NPPESApr 20, 2008

Details

NPI
1255465720
Entity type
Organization (NPI-2)
Legal business name
Jessica Spayd
Organization subpart
No
Enumeration date
Mar 15, 2007
Last updated
Apr 20, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208VP0000X 4245, 677, 20608AKYes
207Q00000X Family Medicine4245, 677, 20608AK
207QA0401X Family Medicine, Addiction Medicine4245, 677, 20608AK
207QS0010X Family Medicine, Sports Medicine4245, 677, 20608AK
208100000X Physical Medicine & Rehabilitation4245, 677, 20608AK
2081P2900X Physical Medicine & Rehabilitation, Pain Medicine4245, 677, 20608AK
208D00000X General Practice4245, 677, 20608AK

Other names

  • Eagle River Pain & Wellness (Former Legal Business Name)

Practice location

11823 Old Glenn Hwy
Suite 110
Eagle River, AK 99577-7734

Phone 907-622-4673 · Fax 907-622-4674

Mailing address

11823 Old Glenn Hwy
Suite 110
Eagle River, AK 99577-7734

Phone 907-622-4673 · Fax 907-622-4674

Authorized official

Jessica J Spayd
Registered Agent
9076224673

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