Mat-Su Plastic Surgery LLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

6242 Issued in AK

Legal business name

MAT-SU PLASTIC SURGERY LLC

Practice address

2490 S Woodworth Loop
Suite 310
Palmer, AK 99645-7405

Phone

(907) 746-6100

NPI assigned

Oct 11, 2011

Last updated

Oct 11, 2011By 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. Susan J Dean, MD

Title

Owner

Phone

(704) 859-6261

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318291200000",
    "number": "1861776791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2490 S WOODWORTH LOOP",
            "address_2": "SUITE 310",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996457405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 S WOODWORTH LOOP",
            "address_2": "SUITE 310",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996457405",
            "telephone_number": "907-746-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAT-SU PLASTIC SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-11",
        "last_updated": "2011-10-11",
        "status": "A",
        "authorized_official_last_name": "DEAN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-859-6261",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "AK",
            "license": "6242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8928018",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Janes House of Healing LLC
• Mat Su Valley Medical Center LLC (Mat-Su Regional Medical Center)
• Mat-Su Dermatology, LLC
• Mat-Su Ear, Nose, Throat & Facial Plastics, Inc.
• Mat-Su Emergency Medicine Physicians Corp
• Mat-Su Regional Medical Center
• Mat-Su Valley III LLC
• Mat-Su Valley III LLC
• Mat-Su Valley III LLC (Mat Su Urgent Care - Palmer)
• Mat-Su Valley III LLC (Mat-Su Urgent Care)

• Plastic Surgery Physician in Palmer, AK
• Providers in Palmer, AK by specialty
• Plastic Surgery Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2011; 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.