Provider Demographics
NPI:1770651762
Name:KACHEMAK BAY MEDICAL CLINIC
Entity Type:Organization
Organization Name:KACHEMAK BAY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-235-7000
Mailing Address - Street 1:4201 BARTLETT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7004
Mailing Address - Country:US
Mailing Address - Phone:907-235-7000
Mailing Address - Fax:907-235-4050
Practice Address - Street 1:4201 BARTLETT ST STE 202
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7004
Practice Address - Country:US
Practice Address - Phone:907-235-7000
Practice Address - Fax:907-235-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK0000WCRBGMedicare ID - Type UnspecifiedCLINC MEDICARE NUMBER