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  7. NPI Record 1679139596

EMPOWER MEDICAL AND WELLNESS
Complete NPI Record 1679139596
Clinic/Center - Primary Care in Palmer, AK

NPI Status: Active since May 16, 2019

Contact Information

1901 N HEMMER RD STE 211
PALMER, AK
ZIP 99645
Phone: (907) 315-4042
Fax: (907) 313-1417

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Second Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider Business Mailing Address Fax Number
  13. Provider First Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Business Practice Location Address Fax Number
  20. Provider Enumeration Date
  21. Last Update Date
  22. Authorized Official Last Name
  23. Authorized Official First Name
  24. Authorized Official Title or Position
  25. Authorized Official Telephone Number
  26. Healthcare Provider Taxonomy Code 1
  27. Healthcare Provider Primary Taxonomy Switch 1
  28. Healthcare Provider Taxonomy Code 2
  29. Healthcare Provider Primary Taxonomy Switch 2
  30. Healthcare Provider Taxonomy Code 3
  31. Healthcare Provider Primary Taxonomy Switch 3
  32. Other Provider Identifier 1
  33. Other Provider Identifier Type Code 1
  34. Other Provider Identifier State 1
  35. Is Organization Subpart
  36. Authorized Official Credential Text
  37. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1679139596. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1679139596
The fax number associated with the location address of the provider being identified.
Entity Type Code: 2
The date the provider was assigned a unique identifier (assigned an NPI).
Employer Identification Number EIN: UNAVAIL
The date that a record was last updated or changed.
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Provider First Line Business Mailing Address: 1150 S COLONY WAY
The first name of the authorized official.
Provider Second Line Business Mailing Address: STE 3 PMB 568
The middle name of the authorized official.
Provider Business Mailing Address City Name: PALMER
The title or position of the authorized official.
Provider Business Mailing Address State Name: AK
The 10-position telephone number of the authorized official.
Provider Business Mailing Address Postal Code: 996456967
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider Business Mailing Address Country Code If outside U S : US
Provider Business Mailing Address Telephone Number: 9073154042
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 9073131417
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1901 N HEMMER RD STE 211
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: PALMER
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: AK
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 996459690
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 9073154042
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 9073131417
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/16/2019
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 2/1/2021
The date that a record was last updated or changed.
Authorized Official Last Name: BRINKE
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: TYFANAE
The first name of the authorized official.
Authorized Official Title or Position: FAMILY NURSE PRACTITIONER
The title or position of the authorized official.
Authorized Official Telephone Number: 9073154042
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 261QH0100X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 261QI0500X
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 261QP2300X
Healthcare Provider Primary Taxonomy Switch 3: Y
Other Provider Identifier 1: 1652161
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: AK
Is Organization Subpart: N
Authorized Official Credential Text: ANP
NPI Certification Date: 10/27/2020