Provider Demographics
NPI:1467559575
Name:MEDICAL EQUIPMENT DISTRIBUTORS OF ALASKA, INC.
Entity type:Organization
Organization Name:MEDICAL EQUIPMENT DISTRIBUTORS OF ALASKA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASCELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-569-0004
Mailing Address - Street 1:3650 LAKE OTIS PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5219
Mailing Address - Country:US
Mailing Address - Phone:907-569-0004
Mailing Address - Fax:866-519-8319
Practice Address - Street 1:3650 LAKE OTIS PKWY STE 202
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5219
Practice Address - Country:US
Practice Address - Phone:907-569-0004
Practice Address - Fax:866-519-8319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK704413332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMS4031Medicaid
AK1021798Medicaid