02D2191505 CLIA NUMBER - ARCTIC MEDICAL CENTER MATSU

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Laboratory Demographics

CLIA Number: 02D2191505

Facility Name: ARCTIC MEDICAL CENTER MATSU

Facility Address:
1734 PROSPECT DR
PALMER, AK
ZIP 99645
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Facility Phone Number: 907 745-2222

Facility Type: Other - NURSE PRACTITIONER

Certificate Type: Waiver

NPI Number: 1578178349

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	02D2191505
LAB Type	Other - NURSE PRACTITIONER
Facility Name	ARCTIC MEDICAL CENTER MATSU
Street	1734 PROSPECT DR
City	PALMER
State	AK
ZIP	99645
Phone	907 745-2222
CertificateType	4
CertificateEffectiveDate	8/27/2022
CertificateExpirationDate	8/26/2024
FacilityType	Waiver

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