Provider Demographics
NPI:1205634649
Name:EDEN MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:EDEN MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HATHCOAT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:907-440-2987
Mailing Address - Street 1:2905 DONINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3844
Mailing Address - Country:US
Mailing Address - Phone:907-440-2987
Mailing Address - Fax:
Practice Address - Street 1:1569 BRAGAW ST STE 102
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3102
Practice Address - Country:US
Practice Address - Phone:907-440-2987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty