Provider Demographics
NPI:1003142621
Name:MAT-SU COMMUNITY PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:MAT-SU COMMUNITY PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAP
Authorized Official - Phone:907-357-2955
Mailing Address - Street 1:3750 E. COUNTRY FIELD CIRCLE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-357-2955
Mailing Address - Fax:907-357-9348
Practice Address - Street 1:3750 E. COUNTRY FIELD CIRCLE
Practice Address - Street 2:SUITE C
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-357-2955
Practice Address - Fax:907-357-9348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty