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02D2131541 CLIA NUMBER - COTTONWOOD CREEK CLINIC, LLC

Laboratory Demographics

CLIA Number: 02D2131541

Facility Name: COTTONWOOD CREEK CLINIC, LLC

Facility Address:
3600 E WICKERSHAM WAY
WASILLA, AK
ZIP 99654
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Facility Phone Number: 907 373-5650

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1134523855

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 02D2131541
LAB Type Physician Office
Facility Name COTTONWOOD CREEK CLINIC, LLC
Street 3600 E WICKERSHAM WAY
City WASILLA
State AK
ZIP 99654
Phone 907 373-5650
CertificateType 4
CertificateEffectiveDate 5/31/2023
CertificateExpirationDate 5/30/2025
FacilityType Waiver

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