Mat-Su Integrative Medicine

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

AK5545 Issued in AK

Legal business name

MAT-SU INTEGRATIVE MEDICINE

Practice address

545 N Knik St
Unit B
Wasilla, AK 99654-7022

Phone

(907) 357-2322

NPI assigned

Aug 3, 2010

Last updated

Aug 3, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ty R VincentNPI 1578578183

Title

Owner

Phone

(907) 357-2322

Specialties & licenses 4

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ty R Vincent, MD

  • Family Medicine Physician
  • Wasilla, AK
  • NPI 1578578183
  NPD (past) Authorized official
• Amy Elder, ANP

  • Women's Health Nurse Practitioner
  • Wasilla, AK
  • NPI 1316093321
  NPD (past)

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

{
    "created_epoch": "1280793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280793600000",
    "number": "1649584566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 N KNIK ST",
            "address_2": "UNIT B",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547022",
            "telephone_number": "907-357-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 N KNIK ST",
            "address_2": "UNIT B",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547022",
            "telephone_number": "907-357-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAT-SU INTEGRATIVE MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-03",
        "last_updated": "2010-08-03",
        "status": "A",
        "authorized_official_last_name": "VINCENT",
        "authorized_official_first_name": "TY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-357-2322",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "364SW0102X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Women's Health",
            "state": "AK",
            "license": "AK560",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "AK",
            "license": "AK134",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "AK5699",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "AK5545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mat-Su Activity and Respite Center
• Mat-Su Birth Center, LLC
• Mat-Su Chiropractic LLC (Mat-Su Chiropractic)
• Mat-Su Community Pediatrics, P.C.
• Mat-Su Dental Center, Inc.
• Mat-Su Medical Laboratory, LLC.
• Mat-Su Mental Health LLC
• Mat-Su Midwifery Inc
• Mat-Su Neurology, LLC
• Mat-Su Pediatric Physical Therapy LLC

• Family Medicine Physician in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Family Medicine Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; 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.