Provider Demographics
NPI:1326753021
Name:MEDICAL NETWORK OF ALASKA, LLC
Entity Type:Organization
Organization Name:MEDICAL NETWORK OF ALASKA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BLOMKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-864-4625
Mailing Address - Street 1:3122 E MERIDIAN PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7255
Mailing Address - Country:US
Mailing Address - Phone:907-864-4625
Mailing Address - Fax:907-357-9593
Practice Address - Street 1:4100 LAKE OTIS PKWY STE 220
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5230
Practice Address - Country:US
Practice Address - Phone:907-563-3145
Practice Address - Fax:907-561-3967
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL NETWORK OF ALASKA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK2173061OtherSTATE OF ALASKA BUSINESS LICENSE
AK2173058OtherSTATE OF ALASKA BUSINESS LICENSE
AK2173060OtherSTATE OF ALASKA BUSINESS LICENSE