| Integrated Womens Wellness & Center For Birth, Llc | |
|
1301 W Parks Hwy Ste 101 Wasilla AK 99654-6939 | |
| (907) 357-7781 | |
| (907) 357-7786 |
| Full Name | Integrated Womens Wellness & Center For Birth, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1301 W Parks Hwy Ste 101, Wasilla, Alaska |
| Authorized Official Name and Position | Hoversten Shantel (OFFICE MANAGER) |
| Authorized Official Contact | 9073577781 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Womens Wellness & Center For Birth, Llc 1301 W Parks Hwy Ste 101 Wasilla AK 99654-6939 Ph: (907) 357-7781 | Integrated Womens Wellness & Center For Birth, Llc 1301 W Parks Hwy Ste 101 Wasilla AK 99654-6939 Ph: (907) 357-7781 |
| NPI Number | 1184806176 |
|---|---|
| Provider Enumeration Date | 11/30/2007 |
| Last Update Date | 07/19/2022 |
| Medicare PECOS PAC ID | 8022170919 |
|---|---|
| Medicare Enrollment ID | O20081231000445 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184806176 | NPI | - | NPPES |
| 1020589 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Darryl Glen Elrod |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1194712810 PECOS PAC ID: 7214099100 Enrollment ID: I20081231000433 |
| Provider Name | Tiffany Jenae Briggs |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1770054082 PECOS PAC ID: 2264770379 Enrollment ID: I20200407002462 |
| Provider Name | Lydia L May |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356710859 PECOS PAC ID: 3072820489 Enrollment ID: I20220802002596 |
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