NPIMap

Organization Active NPI

Medical Network of Alaska, LLC

  • Clinic/Center
  • Wasilla, AK
National Provider Identifier
1497478598
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MEDICAL NETWORK OF ALASKA, LLC
Practice address
3331 E Meridian Park Loop
Wasilla, AK 99654-7294
Phone
(907) 864-4625
Fax
(907) 313-1540
NPI assigned
Sep 22, 2022
Organization subpart
Yes
Parent organization
MEDICAL NETWORK OF ALASKA, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacquelyn Renee Blomker
Title
Director of Revenue Cycle
Phone
(907) 864-4625

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

3331 E Meridian Park Loop
Wasilla, AK 99654-7294

Mailing address

3331 E Meridian Park Loop
Wasilla, AK 99654-7294
Phone (907) 864-4625

Other identifiers 1

IdentifierTypeStateIssuer
2103226OtherAKSTATE OF ALASKA BUSINESS LICENSE

National Provider Directory

National Provider Directory
Tax ID family
Capstone Family Medical9 organizations share this tax ID, including this one
Part of
Capstone Family Medical

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1100 W Dimond Blvd
Anchorage, AK 99515

3331 E Meridian Park Loop
Wasilla, AK 99654
Phone (907) 357-2332

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706572800000",
    "number": "1497478598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3331 E MERIDIAN PARK LOOP",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547294",
            "telephone_number": "907-864-4625",
            "fax_number": "907-313-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3331 E MERIDIAN PARK LOOP",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547294",
            "telephone_number": "907-864-4625",
            "fax_number": "907-313-1540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL NETWORK OF ALASKA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL NETWORK OF ALASKA, LLC",
        "enumeration_date": "2022-09-22",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A",
        "authorized_official_last_name": "BLOMKER",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "907-864-4625"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF ALASKA BUSINESS LICENSE",
            "identifier": "2103226",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.