02D2232615 CLIA NUMBER - TANANA VALLEY CLINIC

Laboratory Demographics

CLIA Number: 02D2232615

Facility Name: TANANA VALLEY CLINIC

Facility Address:
1001 NOBLE STREET
FAIRBANKS, AK
ZIP 99701
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Facility Phone Number: 907 459-3500

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1104067560

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	02D2232615
LAB Type	Physician Office
Facility Name	TANANA VALLEY CLINIC
Street	1001 NOBLE STREET
City	FAIRBANKS
State	AK
ZIP	99701
Phone	907 459-3500
CertificateType	4
CertificateEffectiveDate	8/16/2023
CertificateExpirationDate	8/15/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024