MEDICARE: MAT SU VALLEY MEDICAL CENTER 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
1	207R00000X	Internal Medicine Physician
2	261Q00000X	Clinic/Center	299454	AK
3	261QU0200X	Urgent Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912950148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAT SU VALLEY MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 689022
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-9022
Country	:	US
Telephone Number	:	615-465-7042
Fax Number	:	615-628-6877

Provider Business Practice Location Address
First Line	:	950 E BOGARD RD STE 103
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7184
Country	:	US
Telephone Number	:	907-352-2880
Fax Number	:	907-352-2885

Authorized Official
Title or Position	:	DIRECTOR PROVIDER ENROLLMENT
Name	:	KRISTINA MUSIC
Credential	:
Telephone Number	:	877-892-9815

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	04/21/2025

Similar Medicare Providers

1255333738 — MS. VIRGINIA CAROL COOPER PA-C
Practice Location Address:

950 E BOGARD RD STE 103
WASILLA, AK
99654-7184

Practice Phone: 907-352-2820
Practice Fax: 907-352-2885

1831188473 — LAURA JEAN PETERSON M.D.
Practice Location Address:

950 E BOGARD RD , STE 233
WASILLA, AK
99654-7184

Practice Phone: 907-357-4543
Practice Fax: 907-357-4533

1699765347 — MARIE WESTPHAL MD
Practice Location Address:

950 E BOGARD RD
WASILLA, AK
99654-7184

Practice Phone: 907-357-4534
Practice Fax:

1316999808 — DR. MICHAEL A DIBARTOLO DO
Practice Location Address:

950 E BOGARD RD STE 103
WASILLA, AK
99654-7184

Practice Phone: 907-352-2880
Practice Fax: 907-352-2885

1568476596 — MRS. ELOWYN M SMITH DO
Practice Location Address:

950 E BOGARD RD , SUITE 233
WASILLA, AK
99654-7184

Practice Phone: 907-357-4543
Practice Fax: 907-357-4533

1295878429 — MS. SHAWN ADELE ROBERTS MS FNP
Practice Location Address:

950 E BOGARD RD , SUITE 103
WASILLA, AK
99654-7184

Practice Phone: 907-352-2880
Practice Fax: 907-352-2885

Directions to “MAT SU VALLEY MEDICAL CENTER LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.