# ATLAS MEDICAL ACO LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ATLAS MEDICAL ACO LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1629807086
- **Legal business name:** ATLAS MEDICAL ACO LLC
- **Authorized official:** GREGORY CHAD MANGUM (OWNER)
- **Authorized official phone:** (435) 514-5646

## Contact information

- **Practice address:** 3831 E BLUE LUPINE DR STE C, WASILLA, AK 99654-8461
- **Practice address phone:** (907) 521-2368
- **Mailing address:** PO BOX 4682, LOGAN, UT 84323-4682

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/01/2024
- **Last updated:** 10/17/2024