MAT SU VALLEY MEDICAL CENTER LLC (NPI# 1003838384) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003838384 |
| Entity Type | Organization |
| Organization Name | MAT SU VALLEY MEDICAL CENTER LLC |
| Other Organization Name | MAT-SU REGIONAL MEDICAL CENTER |
| Practice Address |
2500 S Woodworth Loop Palmer AK 99645-8984 |
| Mailing Address |
Po Box 1687 Palmer AK 99645-1687 |
| Practice Telephone | 9078616000 |
| Practice Fax Number | 9078616559 |
| Mailing Telephone | 9078616000 |
| Mailing Fax Number | 9078616559 |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2017-08-04 |
| Authorized Official Name | PAULA M LALOR (DIRECTOR/DELEGATED OFFICIAL) |
| Authorized Official Telephone | 6159254565 |
| Is Organization Subpart | Y |
| Parent Organization Name | MAT SU VALLEY MEDICAL CENTER LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 275N00000X | Medicare Defined Swing Bed Unit | 296969 | AK | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | HS47SB | 05 |
| Other Name | Type Code |
|---|---|
| Mat-Su Regional Medical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932282472 | Mat Su Valley Medical Center LLC | Durable Medical Equipment & Medical Supplies | 950 Bogard Rd, Wasilla, AK 99654-7105 | 2006-10-20 |
| 1669425898 | Mat Su Valley Medical Center LLC | Hospice Care, Community Based | 3051 Palmer Wasilla Hwy, Wasilla, AK 99654-7234 | 2006-05-18 |
| 1912950148 | Mat Su Valley Medical Center LLC | Internal Medicine | 950 Bogard Rd, Wasilla, AK 99654-7105 | 2006-05-18 |
| Street Address |
2500 S WOODWORTH LOOP |
| City | PALMER |
| State | AK |
| Zip Code | 99645-8984 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629067590 | Roy Fukuoka | Nurse Anesthetist, Certified Registered | 2500 S Woodworth Loop, Palmer, AK 99645-8984 | 2005-10-13 |
| 1720603939 | Robert A Grogan | Pharmacist | 2500 S Woodworth Loop, Palmer, AK 99645-8984 | 2020-06-12 |
| 1184258170 | Michelle Hailey Allen | Registered Nurse | 2500 S Woodworth Loop, Palmer, AK 99645-8984 | 2020-02-27 |
| 1528615424 | Tara E Bonardi | Nurse Anesthetist, Certified Registered | 2500 S Woodworth Loop, Palmer, AK 99645-8984 | 2019-08-25 |
| 1619532215 | Eric Atkinson | Registered Nurse | 2500 S Woodworth Loop, Palmer, AK 99645-8984 | 2019-05-08 |
| 1588133748 | Erin Alaina Reding | Nurse Practitioner | 2500 S Woodworth Loop, Palmer, AK 99645-8984 | 2018-11-17 |
| 1043722929 | Fireweed Surgical Assists LLC | Nurse Practitioner | 2500 S Woodworth Loop, Palmer, AK 99645-8984 | 2017-10-31 |
| 1740713866 | Annette Kasprzak | Emergency Medicine | 2500 S Woodworth Loop, Palmer, AK 99645-8984 | 2017-04-05 |
| 1669858106 | Jesse Atwood Md Pediatrics, LLC | Pediatrics | 2500 S Woodworth Loop, Palmer, AK 99645-8984 | 2015-08-06 |
| 1881080018 | Kili Grace O'bryant | Emergency Medicine | 2500 S Woodworth Loop, Palmer, AK 99645 | 2015-04-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295357135 | Kasey M Flintoft | Occupational Therapist | 7200 E. Jim Cottrell Cir, Palmer, AK 99645 | 2020-05-14 |
| 1629601471 | Courtney Randol | Licensed Practical Nurse | 14405 E Pace Dr., Palmer, AK 99645 | 2020-02-20 |
| 1689213092 | Valerie Anne Delaune | Acupuncturist | 9693 N. Little Otter Dr., Palmer, AK 99645 | 2020-01-02 |
| 1003464512 | Alaskan Sunrise Behavioral Health, L.L.C. | Clinic/Center | 14460 E. Pace Dr., Palmer, AK 99645 | 2019-08-28 |
| 1548814718 | Maple Springs of Palmer Snf Holdings, LLC | Skilled Nursing Facility | 12130 E Maple Springs Way, Palmer, AK 99645 | 2019-07-26 |
| 1952868655 | Carla Beth Kelly | Physical Therapist | 7200 Jim Cottrell Circle, Palmer, AK 99645 | 2019-02-28 |
| 1366938375 | Wendy S Page | Behavior Technician | 7200 E Jim Cottrell, Wasilla, AK 99645 | 2018-07-03 |
| 1154845170 | Sarah Elizabeth Gilliland | Occupational Therapist | 7200 E Jim Cottrell Circle, Palmer, AK 99645 | 2017-08-01 |
| 1558885137 | Garland Brooks | Massage Therapist | 1934 Prospect Dr, Palmer, AK 99645 | 2017-07-26 |
| 1386165009 | Sommer Dawn Nielsen | Massage Therapist | 3566 N Mars Ave., Palmer, AK 99645 | 2017-07-03 |
| Find all providers in zip 99645 | ||||
| Taxonomy Code | 275N00000X |
| Grouping | Hospital Units |
| Classification | Medicare Defined Swing Bed Unit |
| A unit of a hospital that has a Medicare provider agreement and has been granted approval from HCFA to provide post-hospital extended care services and be reimbursed as a swing-bed unit. |
| Notes: Source: Code of Federal Regulations #42, Section 482.66. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730548462 | Southeast Alaska Regional Health Consortium | Medicare Defined Swing Bed Unit | 222 Tongass Blvd, Sitka, AK 99835 | 2016-02-23 |
| 1962570903 | Cordova Community Hospital | Medicare Defined Swing Bed Unit | 602 Chase Avenue, Cordova, AK 99574-0160 | 2006-11-30 |
| 1649340217 | City of Seward | Medicare Defined Swing Bed Unit | 417 1st Ave, Seward, AK 99664-0365 | 2006-11-09 |
| 1356829279 | Southeast Alaska Regional Health Consortium | Medicare Defined Swing Bed Unit | 310 Bennett St, Wrangell, AK 99929 | 2018-08-02 |
| 1528544822 | Peacehealth Ketchikan Medical Center | Medicare Defined Swing Bed Unit | 3100 Tongass Ave, Ketchikan, AK 99901-5746 | 2018-07-19 |
| 1184850893 | Norton Sound Health Corporation | Medicare Defined Swing Bed Unit | 1000 Greg Kruschek Ave, Nome, AK 99762 | 2009-06-09 |
| 1093968372 | South Peninsula Hospital, Inc | Medicare Defined Swing Bed Unit | 4300 Bartlett St, Homer, AK 99603-7005 | 2008-10-30 |
| 1609066828 | South East Alaska Regional Health Consortium | Medicare Defined Swing Bed Unit | 222 Tongass Dr, Sitka, AK 99835-9416 | 2007-07-25 |
| 1245352848 | Norton Sound Health Corp | Medicare Defined Swing Bed Unit | 306 W 5th, Nome, AK 99762 | 2007-04-04 |
| 1770645202 | Bristol Bay Area Health Corporation | Medicare Defined Swing Bed Unit | 6000 Kanakanak Rd, Dillingham, AK 99576-0130 | 2006-12-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.