GLACIER SURGICAL ASSOCIATES, INC (NPI# 1568861086) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568861086 |
| Entity Type | Organization |
| Organization Name | GLACIER SURGICAL ASSOCIATES, INC |
| Practice Address |
2490 S Woodworth Loop Suite 450 Palmer AK 99645-7410 |
| Practice Telephone | 9077458100 |
| Practice Fax Number | 9077462655 |
| Mailing Telephone | 9077458100 |
| Mailing Fax Number | 9077462655 |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2014-09-18 |
| Authorized Official Name | DR. SHANNON CHRISTINE GULLEY (PRESIDENT) |
| Authorized Official Telephone | 9077458100 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 8370 | AK | Allopathic & Osteopathic Physicians |
| Street Address |
2490 S WOODWORTH LOOP SUITE 450 |
| City | PALMER |
| State | AK |
| Zip Code | 99645-7410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366443871 | Michael R Senta | Surgery | 2490 S Woodworth Loop, Suite 450, Palmer, AK 99645-7405 | 2005-08-09 |
| 1487017877 | Megan Ferguson | Advanced Practice Midwife | 2490 S Woodworth Loop, Suite 301, Palmer, AK 99645-7410 | 2016-04-01 |
| 1770967598 | Midnight Sun Oncology Partners, LLC | Internal Medicine | 2490 S Woodworth Loop, Suite 499, Palmer, AK 99645-7410 | 2015-07-10 |
| 1972842326 | Brianna Nye | Physician Assistant | 2490 S Woodworth Loop, Suite 350, Palmer, AK 99645-7405 | 2013-02-05 |
| 1508129628 | Cellnetix Pathology, Pllc | Pathology | 2490 S Woodworth Loop, Suite 410, Palmer, AK 99645-7405 | 2012-06-22 |
| 1538422639 | Cellnetix Labs, LLC | Clinical Medical Laboratory | 2490 S Woodworth Loop, Palmer, AK 99645-7405 | 2012-06-22 |
| 1861776791 | Mat-su Plastic Surgery LLC | Plastic Surgery | 2490 S Woodworth Loop, Suite 310, Palmer, AK 99645-7405 | 2011-10-11 |
| 1245538396 | Sarah Wood Johanson | Nurse Practitioner | 2490 S Woodworth Loop, Suite 450, Palmer, AK 99645-7410 | 2011-03-14 |
| 1447570874 | Valley Radiation Oncology | Radiology | 2490 S Woodworth Loop, Suite 150, Palmer, AK 99645-7405 | 2010-06-08 |
| 1912132614 | Michael Montano | Orthopaedic Surgery | 2490 S Woodworth Loop, Suite 200, Palmer, AK 99645-7410 | 2009-05-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295357135 | Kasey M Flintoft | Occupational Therapist | 7200 E. Jim Cottrell Cir, Palmer, AK 99645 | 2020-05-14 |
| 1629601471 | Courtney Randol | Licensed Practical Nurse | 14405 E Pace Dr., Palmer, AK 99645 | 2020-02-20 |
| 1689213092 | Valerie Anne Delaune | Acupuncturist | 9693 N. Little Otter Dr., Palmer, AK 99645 | 2020-01-02 |
| 1003464512 | Alaskan Sunrise Behavioral Health, L.L.C. | Clinic/Center | 14460 E. Pace Dr., Palmer, AK 99645 | 2019-08-28 |
| 1548814718 | Maple Springs of Palmer Snf Holdings, LLC | Skilled Nursing Facility | 12130 E Maple Springs Way, Palmer, AK 99645 | 2019-07-26 |
| 1952868655 | Carla Beth Kelly | Physical Therapist | 7200 Jim Cottrell Circle, Palmer, AK 99645 | 2019-02-28 |
| 1366938375 | Wendy S Page | Behavior Technician | 7200 E Jim Cottrell, Wasilla, AK 99645 | 2018-07-03 |
| 1154845170 | Sarah Elizabeth Gilliland | Occupational Therapist | 7200 E Jim Cottrell Circle, Palmer, AK 99645 | 2017-08-01 |
| 1558885137 | Garland Brooks | Massage Therapist | 1934 Prospect Dr, Palmer, AK 99645 | 2017-07-26 |
| 1386165009 | Sommer Dawn Nielsen | Massage Therapist | 3566 N Mars Ave., Palmer, AK 99645 | 2017-07-03 |
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| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255567046 | Zeling Chau | Surgery | 50 Wright Street, Palmer, MA 01069-1138 | 2009-06-08 |
| 1124149273 | Pruushotam Puri | Surgery | Wright Street, Palmer, MA 01069 | 2007-04-03 |
| 1003995713 | Tak Ming Ko | Surgery | 2480 S Woodworth Loop Ste 180, Palmer, AK 99645-7408 | 2006-11-03 |
| 1891874491 | Brent H Taylor, Md LLC | Surgery | 2490 S. Woodworth Loop, Suite 400, Palmer, AK 99645 | 2006-11-03 |
| 1770685000 | Brent Taylor | Surgery | 2490 S Woodworth Loop Ste 400, Palmer, AK 99645-7411 | 2006-09-05 |
| 1023076007 | Garth W Lecheminant | Surgery | 2490 S Woodworth Loop Ste 450, Palmer, AK 99645-7407 | 2006-05-01 |
| 1366443871 | Michael R Senta | Surgery | 2490 S Woodworth Loop, Suite 450, Palmer, AK 99645-7405 | 2005-08-09 |
| 1053851949 | Alaska Family Health Centers, LLC | Surgery | 425 E Dahlia Ave, Suite L, Palmer, AK 99645-6463 | 2017-02-27 |
| 1235561861 | Tak-ming Ko Md, LLC | Surgery | 2480 S Woodworth Loop Ste 180, Palmer, AK 99645-7408 | 2013-08-06 |
| 1528358173 | Zach Hartman | Surgery | 2490 S Woodworth Loop Ste 450, Palmer, AK 99645-7407 | 2011-04-17 |
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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.