Organization
GLACIER FAMILY MEDICINE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENT ALLEN URSEL PAC (CEO PHYSICIAN ASSISTANT)
(907) 224-8733
Entity
Organization
Contact information
Practice address
11724 SEWARD HWY, STE D, SEWARD, AK 99664-9714
(907) 224-8733
(907) 224-8734
Mailing address
11724 SEWARD HWY, STE D, SEWARD, AK 99664-9714
(907) 224-8733
(907) 224-8734
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
202
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD22813
—
AK
Enumeration date
04/08/2007
Last updated
04/13/2011
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