| Gold Star Longevity & Wellness Llc | |
|
751 Old Richardson Hwy Ste 200 Fairbanks AK 99701-7805 | |
| (907) 457-9420 | |
| (907) 457-1098 |
| Full Name | Gold Star Longevity & Wellness Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 751 Old Richardson Hwy Ste 200, Fairbanks, Alaska |
| Authorized Official Name and Position | Russell Scott Pierce (OWNER, M.D.) |
| Authorized Official Contact | 9074579420 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gold Star Longevity & Wellness Llc 751 Old Richardson Hwy Ste 200 Fairbanks AK 99701-7805 Ph: (907) 457-9420 | Gold Star Longevity & Wellness Llc 751 Old Richardson Hwy Ste 200 Fairbanks AK 99701-7805 Ph: (907) 457-9420 |
| NPI Number | 1427532613 |
|---|---|
| Provider Enumeration Date | 09/24/2018 |
| Last Update Date | 05/11/2021 |
| Medicare PECOS PAC ID | 3173863388 |
|---|---|
| Medicare Enrollment ID | O20190326003103 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427532613 | NPI | - | NPPES |
| Provider Name | Russell S Pierce |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093092116 PECOS PAC ID: 6709016231 Enrollment ID: I20200716001886 |
| Provider Name | Teal L Vinger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578148284 PECOS PAC ID: 8729482013 Enrollment ID: I20210809002840 |
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