Provider Demographics
NPI:1003339334
Name:KENAI PENINSULA HEALTH SYSTEM LLC URGENT CARE OF SOLDOTNA
Entity type:Organization
Organization Name:KENAI PENINSULA HEALTH SYSTEM LLC URGENT CARE OF SOLDOTNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JEOFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:LANFEAR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:406-407-3126
Mailing Address - Street 1:44604 STERLING HWY STE D
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7962
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44604 STERLING HWY STE D
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7962
Practice Address - Country:US
Practice Address - Phone:406-407-3126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1053820261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care