WILD IRIS LLC NPI 1003244211

NPI Information

NPI: 1003244211
Provider Name: WILD IRIS LLC

Doing Business As: WILD IRIS FAMILY MEDICINE AND MATERNITY CARE

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 02D2087545

Address:
851 E WESTPOINT DR
SUITE 207
WASILLA, AK
ZIP 99654
Phone: (907) 373-9463
Get Directions

WILD IRIS LLC is a family medicine 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. WILD IRIS LLC NPI is 1003244211. The provider 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 location address is:

851 E WESTPOINT DR
SUITE 207
WASILLA, AK
ZIP 99654-183
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 CLIA number assigned to this NPI record is 02D2087545 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/25/2013 and was last updated on 10/20/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		5448	ALASKA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	K165366	MEDICARE PIN	ALASKA
2	1012605	MEDICAID	ALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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