Provider Demographics
NPI:1225633449
Name:IDENTITY INC.
Entity Type:Organization
Organization Name:IDENTITY INC.
Other - Org Name:IDENTITY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-929-4528
Mailing Address - Street 1:801 W FIREWEED LN STE 103
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-1893
Mailing Address - Country:US
Mailing Address - Phone:452-890-7929
Mailing Address - Fax:
Practice Address - Street 1:307 E NORTHERN LIGHTS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2701
Practice Address - Country:US
Practice Address - Phone:907-865-3247
Practice Address - Fax:833-992-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty