Provider Demographics
NPI:1396849428
Name:MAT-SU SURGICAL ASSOCIATES APC
Entity Type:Organization
Organization Name:MAT-SU SURGICAL ASSOCIATES APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:W
Authorized Official - Last Name:LECHEMINANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-745-8100
Mailing Address - Street 1:PO BOX 876774
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-6774
Mailing Address - Country:US
Mailing Address - Phone:907-745-9401
Mailing Address - Fax:
Practice Address - Street 1:2490 SOUTH WOODWORTH LOOP
Practice Address - Street 2:SUITE 400
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-745-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5147208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD5147Medicaid
AKMD5147Medicaid
AKK160811Medicare PIN