FAIRBANKS CLINIC INC NPI 1073636148

NPI Information

FAIRBANKS CLINIC INC is a clinic center in Fairbanks, AK. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). FAIRBANKS CLINIC INC NPI is 1073636148. The provider is registered as an organization entity type.

The provider's business location address is:

1405 KELLUM ST STE 201
FAIRBANKS, AK
ZIP 99701-189
Phone: (907) 452-1761
Fax: (844) 531-0274

The provider's authorized official is Tony Nimeh .
The authorized official title is Owner and has the following contact phone number (617) 686-6809.

The CLIA number assigned to this NPI record is 02D0897151 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 4/6/2007 and was last updated on 12/10/2020.

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:

Other Identifiers

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

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