| Cottonwood Creek Clinic Llc | |
|
3600 E Wickersham Way Wasilla AK 99654-7550 | |
| (907) 373-5950 | |
| (907) 373-5954 |
| Full Name | Cottonwood Creek Clinic Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3600 E Wickersham Way, Wasilla, Alaska |
| Authorized Official Name and Position | Richard Blake (OWNER) |
| Authorized Official Contact | 9073735950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cottonwood Creek Clinic Llc 3600 E Wickersham Way Wasilla AK 99654-7550 Ph: (907) 373-5950 | Cottonwood Creek Clinic Llc 3600 E Wickersham Way Wasilla AK 99654-7550 Ph: (907) 373-5950 |
| NPI Number | 1134523855 |
|---|---|
| Provider Enumeration Date | 10/09/2014 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 7810212784 |
|---|---|
| Medicare Enrollment ID | O20150217001928 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134523855 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 1011473 (Alaska) | Primary |
| Provider Name | Katherine N Naylor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013938729 PECOS PAC ID: 6305840356 Enrollment ID: I20071116000390 |
| Provider Name | Tamara L Simpson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881128643 PECOS PAC ID: 4981971496 Enrollment ID: I20170602002062 |
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