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1650 Cowles St Dept 61a Fairbanks AK 99701-5907 | |
| (907) 458-6453 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1650 Cowles St Dept 61a, Fairbanks, Alaska |
| Authorized Official Name and Position | Shelley D Ebenal (GENERAL COUNSEL) |
| Authorized Official Contact | 9074585550 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1650 Cowles St Dept 61a Fairbanks AK 99701-5907 Ph: (907) 458-6453 | 1650 Cowles St Dept 61a Fairbanks AK 99701-5907 Ph: (907) 458-6453 |
| NPI Number | 1942751631 |
|---|---|
| Provider Enumeration Date | 10/18/2016 |
| Last Update Date | 10/18/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942751631 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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