02D2038219 CLIA NUMBER - FRONTIER FAMILY MEDICINE

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Laboratory Demographics

CLIA Number: 02D2038219

Facility Name: FRONTIER FAMILY MEDICINE

Facility Address:
300 W SWANSON AVE
WASILLA, AK
ZIP 99654
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Facility Phone Number: 907 373-3940

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1407195522

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	02D2038219
LAB Type	Practitioner Other
Facility Name	FRONTIER FAMILY MEDICINE
Street	300 W SWANSON AVE
City	WASILLA
State	AK
ZIP	99654
Phone	907 373-3940
CertificateType	4
CertificateEffectiveDate	3/15/2024
CertificateExpirationDate	3/14/2026
FacilityType	Waiver

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