# MEDICAL NETWORK OF ALASKA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDICAL NETWORK OF ALASKA, LLC
- **Other names:** Capstone Diabetes and Endocrinology Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1831763911
- **Legal business name:** MEDICAL NETWORK OF ALASKA, LLC
- **Authorized official:** JACQUELYN RENEE BLOMKER (DIRECTOR OF REVENUE CYCLE)
- **Authorized official phone:** (907) 357-9590

## Contact information

- **Practice address:** 3331 E MERIDIAN PARK LOOP, WASILLA, AK 99654-7294
- **Practice address phone:** (907) 357-9590
- **Mailing address:** 3122 E MERIDIAN PARK LOOP, WASILLA, AK 99654-7255
- **Mailing address phone:** (907) 357-9590
- **Mailing address fax:** (907) 357-9593

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/13/2021
- **Last updated:** 08/02/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2131798 | STATE OF ALASKA BUSINESS LICENSE | AK |