| Urgent Care At Lake Lucille Inc | |
|
185 E Parks Hwy Wasilla AK 99654-7038 | |
| (907) 373-4203 | |
| (907) 373-4201 |
| Full Name | Urgent Care At Lake Lucille Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 185 E Parks Hwy, Wasilla, Alaska |
| Authorized Official Name and Position | Ellen R Varosi (FINANCIAL OFFICER) |
| Authorized Official Contact | 9073734200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Urgent Care At Lake Lucille Inc 185 E Parks Hwy Wasilla AK 99654-7038 Ph: (907) 373-4203 | Urgent Care At Lake Lucille Inc 185 E Parks Hwy Wasilla AK 99654-7038 Ph: (907) 373-4203 |
| NPI Number | 1275587768 |
|---|---|
| Provider Enumeration Date | 05/20/2006 |
| Last Update Date | 05/04/2010 |
| Medicare PECOS PAC ID | 3274526546 |
|---|---|
| Medicare Enrollment ID | O20040405000688 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275587768 | NPI | - | NPPES |
| MDG043 | Medicaid | AK | |
| MDG496 | Medicaid | AK |
| Provider Name | Shawn A Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295878429 PECOS PAC ID: 4183725294 Enrollment ID: I20070719000340 |
| Provider Name | Louis M Packer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407965288 PECOS PAC ID: 7113922378 Enrollment ID: I20120131000861 |
| Provider Name | Tamara L Simpson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881128643 PECOS PAC ID: 4981971496 Enrollment ID: I20170602002062 |
| Provider Name | Nathan Neves George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134638141 PECOS PAC ID: 3375809387 Enrollment ID: I20171108000339 |
| Provider Name | Christi M Angelo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902955891 PECOS PAC ID: 3072602705 Enrollment ID: I20191201000027 |
| Provider Name | Leisha Marie Anderson Fowler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588386528 PECOS PAC ID: 9032585286 Enrollment ID: I20221013001308 |
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Odland Family Practice Clinic, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 950 E Bogard Rd, Suite 234, Wasilla, AK 99654 Phone: 907-355-0850 Fax: 907-373-0117 | |
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