| Mckinley Sports Medicine, Llc | |
|
3745 Geist Rd Fairbanks AK 99709-3554 | |
| (907) 456-3341 | |
| (907) 456-3443 |
| Full Name | Mckinley Sports Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3745 Geist Rd, Fairbanks, Alaska |
| Authorized Official Name and Position | Jennifer K Malcolm (PRESIDENT) |
| Authorized Official Contact | 9074563341 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mckinley Sports Medicine, Llc 3745 Geist Rd Fairbanks AK 99709-3554 Ph: (907) 456-3341 | Mckinley Sports Medicine, Llc 3745 Geist Rd Fairbanks AK 99709-3554 Ph: (907) 456-3341 |
| NPI Number | 1407304017 |
|---|---|
| Provider Enumeration Date | 09/13/2016 |
| Last Update Date | 09/13/2016 |
| Medicare PECOS PAC ID | 8123309465 |
|---|---|
| Medicare Enrollment ID | O20161229000423 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407304017 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | 10040231 (Alaska) | Primary |
| Provider Name | Jennifer K Malcolm |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154583862 PECOS PAC ID: 2668753815 Enrollment ID: I20161229001331 |
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