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02D0993341 CLIA NUMBER - WASILLA INTERNAL MEDICINE LLC

Laboratory Demographics

CLIA Number: 02D0993341

Facility Name: WASILLA INTERNAL MEDICINE LLC

Facility Address:
3719 MERIDIAN LOOP SUITE F
WASILLA, AK
ZIP 99654
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Facility Phone Number: 907 373-5940

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1578110011

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

CLIA Record

Field Name Field Value
CLIA Number 02D0993341
LAB Type Physician Office
Facility Name WASILLA INTERNAL MEDICINE LLC
Street 3719 MERIDIAN LOOP SUITE F
City WASILLA
State AK
ZIP 99654
Phone 907 373-5940
CertificateType 4
CertificateEffectiveDate 11/13/2023
CertificateExpirationDate 11/12/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024