| Fairbanks Psychiatric And Neurological Clinic A Prof Corp | |
|
1919 Lathrop St Suite 220 Fairbanks AK 99701-5937 | |
| (907) 452-1739 | |
| (907) 452-2384 |
| Full Name | Fairbanks Psychiatric And Neurological Clinic A Prof Corp |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1919 Lathrop St, Fairbanks, Alaska |
| Authorized Official Name and Position | Joseph E Beaty (BILLING AGENT) |
| Authorized Official Contact | 9077702301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairbanks Psychiatric And Neurological Clinic A Prof Corp 1919 Lathrop St Suite 220 Fairbanks AK 99701-5937 Ph: (907) 770-2301 | Fairbanks Psychiatric And Neurological Clinic A Prof Corp 1919 Lathrop St Suite 220 Fairbanks AK 99701-5937 Ph: (907) 452-1739 |
| NPI Number | 1518075100 |
|---|---|
| Provider Enumeration Date | 08/25/2006 |
| Last Update Date | 01/16/2019 |
| Medicare PECOS PAC ID | 9931091170 |
|---|---|
| Medicare Enrollment ID | O20040325000179 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518075100 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | James M Foelsch |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1447219589 PECOS PAC ID: 3476590993 Enrollment ID: I20120130000374 |
| Provider Name | Ronald A Martino |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1194793414 PECOS PAC ID: 6204873722 Enrollment ID: I20120404001028 |
| Provider Name | Alisabeth A Thurston-hicks |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043367634 PECOS PAC ID: 4284678228 Enrollment ID: I20120727000109 |
| Provider Name | Kjersti E Bowen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740612118 PECOS PAC ID: 4486938966 Enrollment ID: I20170301000024 |
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