Organization
MAT-SU INTEGRATIVE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TY R VINCENT (OWNER)
(907) 357-2322
Entity
Organization
Contact information
Practice address
545 N KNIK ST, UNIT B, WASILLA, AK 99654-7022
(907) 357-2322
Mailing address
545 N KNIK ST, UNIT B, WASILLA, AK 99654-7022
(907) 357-2322
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
AK134
AK
207Q00000X
Family Medicine Physician
Primary
AK5545
AK
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
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