Healthcare Provider Details

I. General information

NPI: 1164358529
Provider Name (Legal Business Name): SOUTH PENINSULA HOSPITAL KENAI CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SPUR VIEW DR
KENAI AK
99611-6880
US

IV. Provider business mailing address

4300 BARTLETT ST
HOMER AK
99603-7000
US

V. Phone/Fax

Practice location:
  • Phone: 907-235-8101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: RYAN K SMITH
Title or Position: CEO
Credential:
Phone: 907-235-0241