Provider Demographics
NPI:1134599061
Name:BENJAMIN KENNAH PA-C
Entity type:Organization
Organization Name:BENJAMIN KENNAH PA-C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KENNAH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:907-644-6055
Mailing Address - Street 1:2741 DEBARR RD STE C214
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2978
Mailing Address - Country:US
Mailing Address - Phone:907-644-6055
Mailing Address - Fax:907-644-4885
Practice Address - Street 1:2741 DEBARR RD STE C214
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2978
Practice Address - Country:US
Practice Address - Phone:907-644-6055
Practice Address - Fax:907-644-4885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPAEDIC RESEARCH CLINIC OF ALASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK103875363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty