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TANANA VALLEY CLINIC LLC NPI 1073081287


NPI Information

NPI: 1073081287
Provider Name: TANANA VALLEY CLINIC LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
1405 KELLUM ST
FAIRBANKS, AK
ZIP 99701
Phone: (907) 459-3500
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TANANA VALLEY CLINIC LLC is a multi-specialty clinic center in Fairbanks, AK. TANANA VALLEY CLINIC LLC NPI is 1073081287. The provider is registered as an organization entity type.

The provider's business location address is:

1405 KELLUM ST
FAIRBANKS, AK
ZIP 99701-189
Phone: (907) 459-3500

The provider's authorized official is Stephen Paul Leslie .
The authorized official title is Cfo and has the following contact phone number (907) 458-3310.

The enumeration date for this NPI number is 11/6/2018 and was last updated on 11/6/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QM1300XClinic/CenterMulti-SpecialtyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11656193MEDICAIDALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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