NPIMap

Organization Active NPI

Wilderness Medical Relief LLC

  • Health Service Clinic/Center
  • Craig, AK
National Provider Identifier
1477138196
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
WILDERNESS MEDICAL RELIEF LLC
Practice address
403 Hilltop Dr
Craig, AK 99921
Phone
(360) 770-6924
NPI assigned
Mar 15, 2021
Last updated
Mar 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kenneth Wallenfelsz, NPNPI 1457649998
Title
Owner/Manager
Phone
(360) 770-6924

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X NU Primary

Addresses

Primary practice location

403 Hilltop Dr
Craig, AK 99921

Mailing address

802 E Willow St
Sequim, WA 98382-3114

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615766400000",
    "number": "1477138196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 E WILLOW ST",
            "city": "SEQUIM",
            "state": "WA",
            "postal_code": "983823114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 HILLTOP DR",
            "city": "CRAIG",
            "state": "AK",
            "postal_code": "99921",
            "telephone_number": "360-770-6924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDERNESS MEDICAL RELIEF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-15",
        "last_updated": "2021-03-15",
        "certification_date": "2021-02-22",
        "status": "A",
        "authorized_official_last_name": "WALLENFELSZ",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "360-770-6924",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Craig, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.