02D2124353 CLIA NUMBER - NORTHWOODS FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 02D2124353

Facility Name: NORTHWOODS FAMILY MEDICINE

Facility Address:
1301 E PALMER-WASILLA HWY, #400
WASILLA, AK
ZIP 99654
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Facility Phone Number: 907 357-9400

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1528503687

Taxonomy: 207QA0505X - Family Medicine
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.

CLIA Record

Field Name	Field Value
CLIA Number	02D2124353
LAB Type	Physician Office
Facility Name	NORTHWOODS FAMILY MEDICINE
Street	1301 E PALMER-WASILLA HWY, #400
City	WASILLA
State	AK
ZIP	99654
Phone	907 357-9400
CertificateType	4
CertificateEffectiveDate	1/13/2023
CertificateExpirationDate	1/12/2025
FacilityType	Waiver

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