COTTONWOOD CREEK CLINIC LLC (NPI# 1134523855) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134523855 |
| Entity Type | Organization |
| Organization Name | COTTONWOOD CREEK CLINIC LLC |
| Practice Address |
3600 E Wickersham Way Wasilla AK 99654-7550 |
| Practice Telephone | 9073735950 |
| Practice Fax Number | 9073735954 |
| Mailing Telephone | 9073735950 |
| Mailing Fax Number | 9073735954 |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2020-02-14 |
| Authorized Official Name | RICHARD BLAKE (OWNER) |
| Authorized Official Telephone | 9073735950 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 1011473 | AK | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | DEA NUMBER | MB0593726 | 01 |
| Street Address |
3600 E WICKERSHAM WAY |
| City | WASILLA |
| State | AK |
| Zip Code | 99654-7550 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740235829 | Richard W. Blake | Physician Assistant | 3600 E Wickersham Way, Wasilla, AK 99654 | 2006-05-24 |
| 1104317098 | Melissa E San Roman | Hearing Instrument Specialist | 3600 E Wickersham Way, Wasilla, AK 99654-7550 | 2018-05-25 |
| 1952659237 | Jodie H Escot | Hearing Instrument Specialist | 3600 E Wickersham Way, Wasilla, AK 99654-7550 | 2012-08-17 |
| 1124376405 | Raleen A Mccourry | Hearing Instrument Specialist | 3600 E Wickersham Way, Wasilla, AK 99654-7550 | 2012-08-17 |
| 1396093670 | James O Staengel | Hearing Instrument Specialist | 3600 E Wickersham Way, Wasilla, AK 99654-7550 | 2012-08-17 |
| 1831447119 | Otto Inc | Hearing Instrument Specialist | 3600 E Wickersham Way, Wasilla, AK 99654-7550 | 2012-08-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003426784 | Colleen Maggie Newcity | Case Manager/Care Coordinator | 851 Westpoint Suite 310, Wasilla, AK 99654 | 2020-08-06 |
| 1659995884 | Amy M Lowe | Peer Specialist | 1363 W Spuce Ave, Wasilla, AK 99654 | 2020-06-03 |
| 1922648690 | Achieve Medical Alaska LLC | Clinic/Center | 1981 E Palmer, Suite 230, Wasilla, AK 99654 | 2020-01-10 |
| 1588205538 | Juan Carlos Garcia | Physician Assistant | 950 East Bogard Road, Suite 103, Wasilla, AK 99654 | 2019-10-01 |
| 1427610864 | Sharon Webb | Counselor | 705 S Knik Goose Bay Rd Suite K, Wasilla, AK 99654 | 2019-07-06 |
| 1306401864 | Logan Lee Cook | Peer Specialist | 2953 E Fairview Loop, Wasilla, AK 99654 | 2019-05-09 |
| 1053883595 | Moose Creek Medical Clinic LLC | Nurse Practitioner | 2341 S. Fern St., Suite 300, Wasilla, AK 99654 | 2018-12-21 |
| 1487124962 | Melissa A Stevens | Massage Therapist | 2201 W That Rd, Wasilla, AK 99654 | 2018-11-28 |
| 1609359561 | Audrey E Beers | Midwife | 2405 S. Knik Goose Bay Rd., Wasilla, AK 99654 | 2018-09-07 |
| 1093297418 | Karlee Janine Mccorry | Occupational Therapist | 613 S Knik-goose Bay Rd, Wasilla, AK 99654 | 2018-09-01 |
| Find all providers in zip 99654 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427133958 | Partners In Health Medical Clinic | Internal Medicine | 472 N Main St, Suite B, Wasilla, AK 99654-7018 | 2006-10-25 |
| 1861437311 | John D Hunter | Internal Medicine | 1751 Gardner Way, Ste D, Wasilla, AK 99654-6513 | 2006-06-18 |
| 1164479374 | Loetta Mae Horswill-woods | Internal Medicine | 3719 E Meridian Loop, Suite F, Wasilla, AK 99654-7270 | 2006-05-31 |
| 1124081211 | David Barnes | Internal Medicine | 3719 E Meridian Loop Ste A, Wasilla, AK 99654-7273 | 2006-04-10 |
| 1699734673 | Richard J Zajac | Internal Medicine | 950 Bogard Rd, 207, Wasilla, AK 99654-7105 | 2006-03-20 |
| 1316289176 | John D Hunter, Md Inc | Internal Medicine | 1751 E Gardner Way, Ste D, Wasilla, AK 99654-6564 | 2013-03-20 |
| 1962705202 | Heritage Medical Group LLC | Internal Medicine | 501 N Knik St, Wasilla, AK 99654-7050 | 2010-12-08 |
| 1366752560 | Mat-su Valley IIi LLC | Internal Medicine | 950 E Bogard Rd, Suite 207, Wasilla, AK 99654-7184 | 2010-10-21 |
| 1841405883 | Carole Suzanne Ruegsegger | Internal Medicine | 3750 E Country Field Cir, Unit B, Wasilla, AK 99654-6689 | 2007-05-12 |
| 1063529550 | Dirk B Craft | Internal Medicine | 3719 E Meridian Loop, Ste A, Wasilla, AK 99654 | 2006-08-23 |
| Find all providers in WASILLA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.