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MAT - SU HEALTH SERVICES INC. NPI 1184725210


NPI Profile

NPI: 1184725210
Provider Name: MAT - SU HEALTH SERVICES INC.
Classification:Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

CLIA Number: 02D1046987

Address:
1363 W SPRUCE AVE
WASILLA, AK
ZIP 99654
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Phone: (907) 376-2411

MAT - SU HEALTH SERVICES INC. is a mental health (including community mental health center) clinic center in Wasilla, AK. MAT - SU HEALTH SERVICES INC. NPI is 1184725210. The provider is registered as an organization entity type.

The provider's business location address is:

1363 W SPRUCE AVE
WASILLA, AK
ZIP 99654-327
Phone: (907) 376-2411
Fax: (907) 352-3363

The provider's authorized official is Kevin Munson .
The authorized official title is Ceo and has the following contact phone number (907) 376-2411.

The CLIA number assigned to this NPI record is 02D1046987 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/25/2006 and was last updated on 6/10/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)No
2261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)ALASKAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1021831MEDICARE PINALASKA
2MH0469MEDICAIDALASKA
3RH779FQMEDICAIDALASKA
402-1831MEDICARE ID-TYPE UNSPECIFIEDALASKAMEDICARE PART-A FQHC
5K0000WCHFHMEDICARE ID-TYPE UNSPECIFIEDALASKABEHAVIORAL HEALTH UNIT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 1/9/2022

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.