WILD IRIS LLC (WILD IRIS FAMILY MEDICINE AND MATERNITY CARE) - NPI NUMBER 1003244211
Provider Name: WILD IRIS LLC (WILD IRIS FAMILY MEDICINE AND MATERNITY CARE)
NPI Number: 1003244211
Clasification: Family Medicine (207Q00000X)
851 E WESTPOINT DR
Phone Number: (907) 373-9463
WILD IRIS LLC is a family physician in Wasilla, AK. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. The assigned NPI number for this provider is 1003244211 and is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Wild Iris Family Medicine And Maternity Care.
The provider's business address is:
851 E WESTPOINT DR
Phone: (907) 373-9463
The provider's authorized official is Lisa Harrison .
The authorized official title is Owner/physician and has the following contact phone number (907) 373-9463.
The enumeration date for this NPI number is 10/25/2013 and was last updated on 10/20/2014.
Map - Location of Practice
||FAMILY MEDICINE OF ALASKA INC
||NICOLE MARIE PRESSMAN-SCHNEIDER, M.D.
||CHRISTOPHER JAMES SAHLSTROM, MD
||ODLAND FAMILY PRACTICE CLINIC, LLC
||DR. ROBERT NEUBAUER, MD
||MEGAN DULCINEA NYSTROM, DO
||GARY R. KINDELL, M.D.
The following information regarding the scope of practice of this provider is available:
Other (Legacy) Identifiers
The following legacy identifiers are available for this provider:
||Entity Type Code
||Employer Identification Number EIN
||Provider Organization Name Legal Business Name
||WILD IRIS LLC
||Provider Other Organization Name
||WILD IRIS FAMILY MEDICINE AND MATERNITY CARE
||Provider Other Organization Name Type Code
||Provider First Line Business Practice Location Address
||851 E WESTPOINT DR
||Provider Second Line Business Practice Location Address
||Provider Business Practice Location Address City Name
||Provider Business Practice Location Address State Name
||Provider Business Practice Location Address Postal Code
||Provider Business Practice Location Address Country Code If outside U S
||Provider Business Practice Location Address Telephone Number
||Provider Enumeration Date
||Last Update Date
||Authorized Official Last Name
||Authorized Official First Name
||Authorized Official Title or Position
||Authorized Official Telephone Number
||Healthcare Provider Taxonomy Code 1
||Provider License Number 1
||Provider License Number State Code 1
||Healthcare Provider Primary Taxonomy Switch 1
||Other Provider Identifier 1
||Other Provider Identifier Type Code 1
||Other Provider Identifier State 1
||Other Provider Identifier 2
||Other Provider Identifier Type Code 2
||Other Provider Identifier State 2
||Is Organization Subpart
||Authorized Official Name Prefix Text
||Authorized Official Credential Text
||Healthcare Provider Taxonomy Group 1
||193400000X SINGLE SPECIALTY GROUP
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This page was last updated on: 11/14/2014
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