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NPI Code Detail

MEDICARE: MEDICAL NETWORK OF ALASKA, LLC

MEDICARE: MEDICAL NETWORK OF ALASKA, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician
2207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1013551456
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDICAL NETWORK OF ALASKA, LLC
Provider Business Mailing Address
First Line : 3122 E MERIDIAN PARK LOOP
Second Line :
City : WASILLA
State : AK
Zip : 99654-7255
Country : US
Telephone Number : 907-357-9590
Fax Number : 907-357-9593
Provider Business Practice Location Address
First Line : 10543 KENAI SPUR HWY
Second Line :
City : KENAI
State : AK
Zip : 99611-7812
Country : US
Telephone Number : 907-357-9590
Fax Number : 907-357-9593
Authorized Official
Title or Position : RCM
Name : JACQUELYN RENEE BLOMKER
Credential :
Telephone Number : 907-864-4625
Provider Enumeration Date : 10/29/2019
Last Update Date : 11/02/2020

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