Healthcare Provider Details

I. General information

NPI: 1730132911
Provider Name (Legal Business Name): MAT-SU VALLEY MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 PALMER WASILLA HWY
WASILLA AK
99654-7234
US

IV. Provider business mailing address

PO BOX 60000 LOCKBOX 74470
SAN FRANCISCO CA
94160
US

V. Phone/Fax

Practice location:
  • Phone: 907-861-6000
  • Fax: 907-861-6559
Mailing address:
  • Phone: 907-861-6000
  • Fax: 907-861-6559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number297764
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LAURIE HOLTSFORD
Title or Position: DIRECTOR BUSINESS OFFICE SUPPORT
Credential:
Phone: 615-465-7488