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General NPI Number Information
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NPI Number | 1407778483
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Entity Type | Organization
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Legal Business Name | MAT-SU VALLEY III LLC
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 2490 S WOODWORTH LOOP STE 301
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City | PALMER
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State | AK
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Zip | 99645-7407
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Country | US
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Telephone | 907-861-6700
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Fax | 833-464-3851
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone | 615-465-7000
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, PROVIDER ENROLLMENT
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Name | KRISTY MUSIC
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Credential |
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Telephone | 877-892-9815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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