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
1	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1922862986
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	:

Provider Business Practice Location Address
First Line	:	1100 E DIMOND BLVD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-2010
Country	:	US
Telephone Number	:	907-864-4625
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF REVENUE CYCLE
Name	:	JACQUELYN RENEE BLOMKER
Credential	:
Telephone Number	:	907-357-9590

Provider Enumeration Date	:	02/09/2024
Last Update Date	:	02/09/2024

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