| Flt Llc | |
|
250 Cushman St Ste 4f Fairbanks AK 99701-4665 | |
| (907) 457-1128 | |
| (907) 457-1124 |
| Full Name | Flt Llc |
|---|---|
| Speciality | Social Worker |
| Location | 250 Cushman St Ste 4f, Fairbanks, Alaska |
| Authorized Official Name and Position | Randy Lewis (MANAGING MEMBER) |
| Authorized Official Contact | 9074571128 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Flt Llc Po Box 80361 Fairbanks AK 99708-0361 Ph: (907) 457-1128 | Flt Llc 250 Cushman St Ste 4f Fairbanks AK 99701-4665 Ph: (907) 457-1128 |
| NPI Number | 1306215587 |
|---|---|
| Provider Enumeration Date | 09/17/2015 |
| Last Update Date | 03/04/2016 |
| Medicare PECOS PAC ID | 2466803861 |
|---|---|
| Medicare Enrollment ID | O20240110002776 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306215587 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 1025780 (Alaska) | Primary |
| Provider Name | Alfred R Lewis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588648257 PECOS PAC ID: 0547352874 Enrollment ID: I20070816000449 |
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