# MAT-SU INTEGRATIVE MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649584566
- **Authorized official:** DR. TY R VINCENT (OWNER)
- **Authorized official phone:** (907) 357-2322

## Contact information

- **Practice address:** 545 N KNIK ST, UNIT B, WASILLA, AK 99654-7022
- **Practice address phone:** (907) 357-2322
- **Mailing address:** 545 N KNIK ST, UNIT B, WASILLA, AK 99654-7022
- **Mailing address phone:** (907) 357-2322

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171100000X | Acupuncturist | AK134 | AK | — |
| 207Q00000X | Family Medicine Physician | AK5545 | AK | Yes |
| 207Q00000X | Family Medicine Physician | AK5699 | AK | — |
| 364SW0102X | Women's Health Clinical Nurse Specialist | AK560 | AK | — |

## Other

- **Enumeration date:** 08/03/2010
- **Last updated:** 08/03/2010