Provider Demographics
NPI:1003838384
Name:MAT SU VALLEY MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MAT SU VALLEY MEDICAL CENTER LLC
Other - Org Name:MAT-SU REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:PO BOX 1687
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-1687
Mailing Address - Country:US
Mailing Address - Phone:907-861-6000
Mailing Address - Fax:907-861-6559
Practice Address - Street 1:2500 S WOODWORTH LOOP
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8984
Practice Address - Country:US
Practice Address - Phone:907-861-6000
Practice Address - Fax:907-861-6559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAT SU VALLEY MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-24
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK296969275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS47SBMedicaid
AKHS47SBMedicaid