Provider Demographics
NPI:1033387972
Name:CATHERINE LOUISE PEIMANN
Entity Type:Organization
Organization Name:CATHERINE LOUISE PEIMANN
Other - Org Name:SOUTHEAST MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEIMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-586-8100
Mailing Address - Street 1:641 W WILLOUGHBY AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-586-8100
Mailing Address - Fax:907-586-8102
Practice Address - Street 1:641 W WILLOUGHBY AVE
Practice Address - Street 2:STE 201
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-586-8100
Practice Address - Fax:907-586-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK152948Medicare PIN