Organization
MAT - SU HEALTH SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN MUNSON (CEO)
(907) 376-2411
Entity
Organization
Contact information
Practice address
1363 W SPRUCE AVE, WASILLA, AK 99654-5327
(907) 376-2411
(907) 352-3363
Mailing address
1363 W SPRUCE AVE, WASILLA, AK 99654-5327
(907) 376-2411
(907) 352-3363
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MH0469
—
AK
05
—
RH779FQ
—
AK
Enumeration date
09/25/2006
Last updated
06/10/2010
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