Matanuska Susitna Borough

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

0425 Issued in AK

Legal business name

MATANUSKA SUSITNA BOROUGH

Practice address

350 E Dahlia Ave
Palmer, AK 99645-6411

Phone

(907) 745-9564

Fax

(907) 745-9566

NPI assigned

Oct 27, 2005

Last updated

Aug 11, 2025By 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

Edna B Devries

Title

Borough Mayer

Phone

(907) 861-8564

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Matanuska Susitna Borough Ambulance Former legal business name

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Locations

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754870400000",
    "number": "1861482903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 E DAHLIA AVE",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996456411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 E DAHLIA AVE",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996456411",
            "telephone_number": "907-745-9564",
            "fax_number": "907-745-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATANUSKA SUSITNA BOROUGH",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-27",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A",
        "authorized_official_last_name": "DEVRIES",
        "authorized_official_first_name": "EDNA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "BOROUGH MAYER",
        "authorized_official_telephone_number": "907-861-8564"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "AK",
            "license": "0425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590001961",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TRO688",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Matanuska Susitna Borough Ambulance",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Mat-Su Valley III LLC
• Mat-Su Valley III LLC (Mat Su Urgent Care - Palmer)
• Mat-Su Valley III LLC (Mat-Su Urgent Care)
• Mat-Su Valley Medical Center LLC (Mat-Su Regional Medical Center)
• Matanuska Mama, LLC
• Matanuska-Susitna Borough School District
• Crystal Lynn Mathis
• Matsu Baby Co LLC
• Kailey Marie Matzen, DPT
• Luke Matzen, PT, DPT

• Land Ambulance in Palmer, AK
• Providers in Palmer, AK by specialty
• Land Ambulance in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.