SURGERY CENTER OF WASILLA LLC NPI 1649534843

NPI Information

NPI: 1649534843
Provider Name: SURGERY CENTER OF WASILLA, LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 02D2048224

Address:
3190 E MERIDIAN PARK LOOP STE 111
WASILLA, AK
ZIP 99654
Phone: (907) 631-3578
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SURGERY CENTER OF WASILLA, LLC is an ambulatory surgical clinic center in Wasilla, AK. SURGERY CENTER OF WASILLA, LLC NPI is 1649534843. The provider is registered as an organization entity type.

The provider's business location address is:

3190 E MERIDIAN PARK LOOP STE 111
WASILLA, AK
ZIP 99654-422
Phone: (907) 631-3578
Fax: (907) 782-4561

The provider's authorized official is John Thomas Grissom .
The authorized official title is President and has the following contact phone number (907) 631-3578.

The CLIA number assigned to this NPI record is 02D2048224 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/2/2012 and was last updated on 5/16/2018.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	976033	ALASKA	Yes

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: 11/14/2023

NPI Synchronization or Removal

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