Provider Demographics
NPI:1467812693
Name:PENINSULA SURGERY AND AESTHETICS
Entity Type:Organization
Organization Name:PENINSULA SURGERY AND AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-299-0737
Mailing Address - Street 1:PO BOX 1862
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-1862
Mailing Address - Country:US
Mailing Address - Phone:907-299-0737
Mailing Address - Fax:
Practice Address - Street 1:104 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7546
Practice Address - Country:US
Practice Address - Phone:907-299-0737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2272261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy