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General NPI Number Information
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NPI Number | 1861935975
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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 | 11/21/2016
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 5851 SOUTH KNIK-GOOSE BAY ROAD
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City | WASILLA
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State | AK
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Zip | 99623
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Country | US
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Telephone | 907-864-1300
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Fax | 907-864-1305
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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 | 615-465-7377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State | AK
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