| Name: | MEDICAL NETWORK OF ALASKA, LLC |
| Jurisdiction: | Alaska |
| Legal type: | Limited Liability Company |
| Status: | Good Standing |
| Date of registration: | 13 Oct 2006 (18 years ago) |
| Entity Number: | 103547 |
| ZIP code: | 99654 |
| County: | Matanuska Susitna |
| Place of Formation: | ALASKA |
| Address: | 3331 E MERIDIAN PARK LP, WASILLA, AK 99654 |
Line of Business
62 Health Care and Social AssistanceNAICS
621111 OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)| Name | Role |
|---|---|
| CAPSTONE URGENT CARE, LLC | Member |
| Alpenglow Women's Health, LLC | Member |
| WADE ERICKSON | Registered Agent |
| CAPSTONE DIABETES AND EDOCRINOLOGY, LLC | Member |
| Anchorage Fracture and Orthopaedic Clinic, P.C. | Member |
| Capstone Family Physicians, LLC | Member |
| Unique Entity ID | Expiration Date | Physical Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| K6ZZJ9YLJXZ7 | 2024-05-30 | 3122 E MERIDIAN PARK LOOP, WASILLA, AK, 99654, 7255, USA | |||||||||||||||||||||||||||||||||||||||||||||
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| URL | www.capstoneclinic.com |
| Division Name | CAPSTONE FAMILY MEDICINE |
| Congressional District | 00 |
| State/Country of Incorporation | AK, USA |
| Activation Date | 2023-06-02 |
| Initial Registration Date | 2021-03-11 |
| Entity Start Date | 2019-07-01 |
| Fiscal Year End Close Date | Dec 31 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | JACQUELYN R BLOMKER |
| Role | DIRECTOR OF REVENUE CYCLE |
| Address | 3122 E MERIDIAN PARK LOOP, WASILLA, AK, 99654, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | JACQUELYN R BLOMKER |
| Role | DIRECTOR OF REVENUE CYCLE |
| Address | 3122 E MERIDIAN PARK LOOP, WASILLA, AK, 99654, USA |
| Past Performance | - |
|---|
| License Number | Type | Status | Issue Date | Date of renewal | Expiration date | Description |
|---|---|---|---|---|---|---|
| 2103226 | Business License | Active | 2020-04-21 | 2024-12-26 | 2026-12-31 | LOB: 62 - Health Care and Social Assistance, NAICS: 621111 - OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS) |
| License Number | Program | Type | Status | Issue Date | Effective Date | Expiration Date |
|---|---|---|---|---|---|---|
| 129753 | Telemedicine Business Registry | Telemedicine Business Registry | Active | 2018-01-18 | 2018-01-18 | - |
| 146960 | Telemedicine Business Registry | Telemedicine Business Registry | Active | 2019-05-20 | 2019-05-20 | - |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 344888326 | 1050210 | 2020-08-17 | 3122 E MERIDIAN PARK LOOP, WASILLA, AK, 99654 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Citation ID | 01001A |
| Citaton Type | Serious |
| Standard Cited | 19101030 C01 I |
| Issuance Date | 2021-01-29 |
| Abatement Due Date | 2021-03-18 |
| Current Penalty | 8675.0 |
| Initial Penalty | 8675.0 |
| Final Order | 2021-02-25 |
| Nr Instances | 1 |
| Nr Exposed | 5 |
| Gravity | 5 |
| FTA Current Penalty | 0.0 |
| Citation ID | 01001B |
| Citaton Type | Serious |
| Standard Cited | 19101030 F01 I |
| Issuance Date | 2021-01-29 |
| Abatement Due Date | 2021-03-18 |
| Current Penalty | 0.0 |
| Initial Penalty | 0.0 |
| Final Order | 2021-02-25 |
| Nr Instances | 1 |
| Nr Exposed | 5 |
| Gravity | 5 |
| FTA Current Penalty | 0.0 |
| Citation ID | 01001C |
| Citaton Type | Serious |
| Standard Cited | 19101030 H02 II |
| Issuance Date | 2021-01-29 |
| Abatement Due Date | 2021-03-18 |
| Current Penalty | 0.0 |
| Initial Penalty | 0.0 |
| Final Order | 2021-02-25 |
| Nr Instances | 2 |
| Nr Exposed | 5 |
| Gravity | 5 |
| FTA Current Penalty | 0.0 |
| Citation ID | 01002 |
| Citaton Type | Serious |
| Standard Cited | 19101030 G01 I |
| Issuance Date | 2021-01-29 |
| Abatement Due Date | 2021-02-25 |
| Current Penalty | 6940.0 |
| Initial Penalty | 6940.0 |
| Final Order | 2021-02-25 |
| Nr Instances | 1 |
| Nr Exposed | 5 |
| Gravity | 5 |
| FTA Current Penalty | 0.0 |
| Citation ID | 01003A |
| Citaton Type | Serious |
| Standard Cited | 19101200 E01 |
| Issuance Date | 2021-01-29 |
| Abatement Due Date | 2021-03-18 |
| Current Penalty | 6940.0 |
| Initial Penalty | 6940.0 |
| Final Order | 2021-02-25 |
| Nr Instances | 1 |
| Nr Exposed | 6 |
| Gravity | 5 |
| FTA Current Penalty | 0.0 |
| Citation ID | 01003B |
| Citaton Type | Serious |
| Standard Cited | 19101200 G01 |
| Issuance Date | 2021-01-29 |
| Abatement Due Date | 2021-03-18 |
| Current Penalty | 0.0 |
| Initial Penalty | 0.0 |
| Final Order | 2021-02-25 |
| Nr Instances | 5 |
| Nr Exposed | 6 |
| Gravity | 5 |
| FTA Current Penalty | 0.0 |
| Citation ID | 01003C |
| Citaton Type | Serious |
| Standard Cited | 19101200 H01 |
| Issuance Date | 2021-01-29 |
| Abatement Due Date | 2021-03-18 |
| Current Penalty | 0.0 |
| Initial Penalty | 0.0 |
| Final Order | 2021-02-25 |
| Nr Instances | 2 |
| Nr Exposed | 6 |
| Gravity | 5 |
| FTA Current Penalty | 0.0 |
| Citation ID | 02001 |
| Citaton Type | Other |
| Standard Cited | 19100037 B04 |
| Issuance Date | 2021-01-29 |
| Abatement Due Date | 2021-02-25 |
| Current Penalty | 0.0 |
| Initial Penalty | 0.0 |
| Final Order | 2021-02-25 |
| Nr Instances | 1 |
| Nr Exposed | 6 |
| FTA Current Penalty | 0.0 |
| Citation ID | 02002 |
| Citaton Type | Other |
| Standard Cited | 19100037 B05 |
| Issuance Date | 2021-01-29 |
| Abatement Due Date | 2021-02-25 |
| Current Penalty | 0.0 |
| Initial Penalty | 0.0 |
| Final Order | 2021-02-25 |
| Nr Instances | 4 |
| Nr Exposed | 6 |
| FTA Current Penalty | 0.0 |
Date of last update: 24 Jan 2025
Sources: State of Alaska - Department of Commerce, Community, and Economic Development
