| Redoubt Medical Group Llc. | |
|
416 Frontage Rd Ste 200 Kenai AK 99611-7770 | |
| (907) 283-6030 | |
| (907) 283-3194 |
| Full Name | Redoubt Medical Group Llc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 416 Frontage Rd Ste 200, Kenai, Alaska |
| Authorized Official Name and Position | Joan Itano Merrick (OFFICE MANAGER) |
| Authorized Official Contact | 9072836030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Redoubt Medical Group Llc. 416 Frontage Rd Ste 200 Kenai AK 99611-7770 Ph: (907) 283-6030 | Redoubt Medical Group Llc. 416 Frontage Rd Ste 200 Kenai AK 99611-7770 Ph: (907) 283-6030 |
| NPI Number | 1386391696 |
|---|---|
| Provider Enumeration Date | 03/07/2022 |
| Last Update Date | 03/08/2022 |
| Medicare PECOS PAC ID | 2961898366 |
|---|---|
| Medicare Enrollment ID | O20220412002218 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386391696 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Joan C Itano Merrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912075482 PECOS PAC ID: 6901845791 Enrollment ID: I20050502000238 |
| Provider Name | Renae M Blanton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639107824 PECOS PAC ID: 5799795464 Enrollment ID: I20060425000560 |
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