Provider Demographics
NPI:1497478598
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 1:3331 E MERIDIAN PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7294
Mailing Address - Country:US
Mailing Address - Phone:907-864-4625
Mailing Address - Fax:907-313-1540
Practice Address - Street 1:3331 E MERIDIAN PARK LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7294
Practice Address - Country:US
Practice Address - Phone:907-864-4625
Practice Address - Fax:907-313-1540
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL NETWORK OF ALASKA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-22
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK2103226OtherSTATE OF ALASKA BUSINESS LICENSE