Provider Demographics
NPI:1992992457
Name:S LYNN HORNBEIN
Entity type:Organization
Organization Name:S LYNN HORNBEIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HORNBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-272-3366
Mailing Address - Street 1:440A W EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6955
Mailing Address - Country:US
Mailing Address - Phone:907-746-3366
Mailing Address - Fax:
Practice Address - Street 1:2741 DEBARR RD STE C308
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2972
Practice Address - Country:US
Practice Address - Phone:907-272-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2515261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2515Medicaid