VACCA PHYSIATRY LLC (NPI# 1528456696) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528456696 |
| Entity Type | Organization |
| Organization Name | VACCA PHYSIATRY LLC |
| Practice Address |
10928 Eagle River Rd Suite 104 Eagle River AK 99577-8078 |
| Practice Telephone | 9076221300 |
| Mailing Telephone | 9076221300 |
| Enumeration Date | 2014-12-24 |
| Last Update Date | 2016-06-07 |
| Authorized Official Name | BRIAN D VACCA (OWNER/SOLE PROVIDER) |
| Authorized Official Telephone | 9076221300 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208100000X | Physical Medicine & Rehabilitation | 51455 | MN | Allopathic & Osteopathic Physicians |
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
103783 | AK | Ambulatory Health Care Facilities |
| Street Address |
10928 EAGLE RIVER RD SUITE 104 |
| City | EAGLE RIVER |
| State | AK |
| Zip Code | 99577-8078 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669463923 | Hal E Hagge | Optometrist | 10928 Eagle River Rd, Ste.# 102, Eagle River, AK 99577-8038 | 2005-11-03 |
| 1053762062 | Nervana Health Solutions LLC | Chiropractor | 10928 Eagle River Rd, # 104, Eagle River, AK 99577-8078 | 2016-06-30 |
| 1285048124 | Adam Bellendier | Chiropractor | 10928 Eagle River Rd, Suite 104, Eagle River, AK 99577-8078 | 2014-06-18 |
| 1922436328 | Tincher Therapy Services | Clinic/Center | 10928 Eagle River Rd, #140, Eagle River, AK 99577-8038 | 2013-10-22 |
| 1679836506 | Mary Elizabeth Smith | Nurse Practitioner | 10928 Eagle River Rd, Ste 254, Eagle River, AK 99577-8038 | 2012-06-15 |
| 1407171069 | Northern Anesthesia and Pain Medicine, LLC | Pain Medicine | 10928 Eagle River Rd, Suite 240, Eagle River, AK 99577-8078 | 2010-04-06 |
| 1831347889 | Alfred Montague Land Iv | Dentist | 10928 Eagle River Rd, Suite 250, Eagle River, AK 99577-8038 | 2008-09-03 |
| 1053531491 | Daniel J Young | Acupuncturist | 10928 Eagle River Rd, Suite 254, Eagle River, AK 99577-8038 | 2007-04-26 |
| 1912048679 | Kenneth Richard Helm | Dentist | 10928 Eagle River Rd, Suite 202, Eagle River, AK 99577-8078 | 2007-02-08 |
| 1417041526 | Brian Domenic Vacca | Physical Medicine & Rehabilitation | 10928 Eagle River Rd, Suite 104, Eagle River, AK 99577-8078 | 2006-10-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831758333 | Dianne E Lyons | Behavior Technician | 16331 Heritage Place, Suite 101, Eagle River, AK 99577 | 2019-06-07 |
| 1073007209 | Center for Natural Medicine, Inc. | Acupuncturist | 16844 Easy St, Eagle River, AK 99577 | 2018-06-20 |
| 1538652748 | Shelly Rana Budde | Nurse Practitioner | 19139 Upper Skyline Dr, Eagle River, AK 99577 | 2018-06-12 |
| 1700387529 | Aaron Wesley Jones | Behavior Technician | 16941 Notrh Eagle River Loop Road, Eagle River, Ak, AK 99577 | 2018-02-27 |
| 1033641881 | Sierra Bracken | Massage Therapist | 12812 Old Glenn Hwy, Ste C3, Eagle River, AK 99577 | 2017-03-31 |
| 1699213231 | Jolene Denee Rogers | Counselor | 13620 Old Glenn Hwy, Ste C, Eagle River, AK 99577 | 2017-02-02 |
| 1881040962 | Elizabeth Hanson | Behavioral Analyst | 16941 North Eagle River Loop Road, Suite 3, Eagle River, AK 99577 | 2016-05-09 |
| 1023496148 | Joel Richard Wallace | Dentist | 16727 Farm Avenue, Eagle River, AK 99577 | 2015-05-08 |
| 1184019663 | Nicole Christine Newman | Physician Assistant | 11432 Business Blvd., Suite 4, Eagle River, AK 99577 | 2015-04-01 |
| 1417365362 | Tammi Smith | Community Health Worker | 16510 Centerfield Dr B 107, Eagle River, AK 99577 | 2014-07-23 |
| Find all providers in zip 99577 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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| 1922648690 | Achieve Medical Alaska LLC | Clinic/Center | 1981 E Palmer, Suite 230, Wasilla, AK 99654 | 2020-01-10 |
| 1376075697 | Seven Principles Therapeutics | Clinic/Center | 505 W Northern Lights Bvld, Anchorage, AK 99503 | 2017-03-28 |
| 1710347349 | Solstice Medicine & Wellness, LLC | Clinic/Center | 475 Riverstone Way # 5, Fairbanks, AK 99709-2945 | 2016-02-24 |
| 1730482407 | American Hyperbaric Centers, Inc. | Clinic/Center | 2710 Wesleyan Drive, Suite 201, Anchorage, AK 99508-3776 | 2010-12-17 |
| 1447577200 | Advanced Body Solutions, Inc. | Clinic/Center | 626 Cordova Street Suite 105, Advanced Body Solutions, Anchorage, AK 99501 | 2010-05-03 |
| 1366674699 | Colleen M. Murphy, Md, Facog, Corp | Clinic/Center | 4100 Lake Otis Pkwy Ste 330, Anchorage, AK 99508-5232 | 2009-08-20 |
| 1295988491 | Eastern Aleutian Tribes | Clinic/Center | 1 Airport Rd, Cold Bay, AK 99571 | 2008-10-31 |
| 1881879922 | Wisdom Traditions Counseling Services, LLC | Clinic/Center | 401 W International Rd Ste 27, Anchorage, AK 99518-1168 | 2008-01-08 |
| 1891790184 | Independence Healthcare PC | Clinic/Center | 291 N Fireweed St, Soldotna, AK 99669-7540 | 2005-06-14 |
| 1578178349 | Arctic Medical Center Matsu | Clinic/Center | 1734 Prospect Dr, Palmer, AK 99645 | 2020-09-09 |
| Find all providers with the same taxonomy | ||||
| City | EAGLE RIVER |
| Zip Code | 99577 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.