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Organization
MEDICAL NETWORK OF ALASKA, LLC
Active
Organization
MEDICAL NETWORK OF ALASKA, LLC
Active
Parent organization
MEDICAL NETWORK OF ALASKA, LLC
Other names
Capstone Diabetes and Endocrinology Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDICAL NETWORK OF ALASKA, LLC
Authorized official
JACQUELYN RENEE BLOMKER (DIRECTOR OF REVENUE CYCLE)
(907) 357-9590
Entity
Organization
Contact information
Practice address
3331 E MERIDIAN PARK LOOP, WASILLA, AK 99654-7294
(907) 357-9590
Mailing address
3122 E MERIDIAN PARK LOOP, WASILLA, AK 99654-7255
(907) 357-9590
(907) 357-9593
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2131798
STATE OF ALASKA BUSINESS LICENSE
AK
Enumeration date
05/13/2021
Last updated
08/02/2021
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