Organization Name: | MULDOON ASC LLC |
NPI Number: | 1003265315 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DONALD E WELLER (ADMINISTRATOR) |
Mailing Address: | 6911 Debarr Rd Anchorage |
State: | AK US |
Postal Code: | 995041806 |
Phone Number: | 9072051545 |
Fax Number: | |
NPI Enumeration Date: | 06/07/2016 |
NPI Last Update Date: | 06/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |