Provider Demographics
NPI:1841469996
Name:PENINSULA EAR, NOSE & THROAT CLINIC, INC.
Entity type:Organization
Organization Name:PENINSULA EAR, NOSE & THROAT CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:ZIRUL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:907-283-5400
Mailing Address - Street 1:220 SPUR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-6880
Mailing Address - Country:US
Mailing Address - Phone:907-283-5400
Mailing Address - Fax:
Practice Address - Street 1:220 SPUR VIEW DR
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6880
Practice Address - Country:US
Practice Address - Phone:907-283-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK911644261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center