Organization
R LYNN CARLSON MD PC MEDICENTER
Active
Parent organization
R LYNN CARLSON MD PC MEDICENTER
Other names
MediCenter North RHC
Organization subpart
Yes
Provider details
NPI number
Legal business name
R LYNN CARLSON MD PC MEDICENTER
Authorized official
JOSEPH A HURLEY BM, PFS (EXECUTIVE DIRECTOR)
(360) 771-7458
Entity
Organization
Contact information
Practice address
43783 KENAI SPUR HWY, NIKISKI, AK 99611-9708
(907) 283-9116
(907) 283-9122
Mailing address
PO BOX 240, KENAI, AK 99611-0240
(907) 283-9118
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PADA895
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008129
—
AK
05
—
1010950
—
AK
05
—
1012124
—
AK
05
—
1020379
—
AK
05
—
1584686
—
AK
05
—
1625263
—
AK
Enumeration date
05/25/2016
Last updated
05/01/2018
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