Provider Demographics
NPI:1861482903
Name:MATANUSKA SUSITNA BOROUGH
Entity Type:Organization
Organization Name:MATANUSKA SUSITNA BOROUGH
Other - Org Name:MATANUSKA SUSITNA BOROUGH AMBULANCE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BOROUGH MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-745-9689
Mailing Address - Street 1:350 E DAHLIA AVE
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 E DAHLIA AVE
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6411
Practice Address - Country:US
Practice Address - Phone:907-745-9564
Practice Address - Fax:907-745-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK04253416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKTRO688Medicaid
AKTRO688Medicaid