1720039076 NPI number — FAIRBANKS NORTH STAR BOROUGH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720039076 NPI number — FAIRBANKS NORTH STAR BOROUGH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRBANKS NORTH STAR BOROUGH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720039076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 71122
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRBANKS
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99707-1122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-459-8200
Provider Business Mailing Address Fax Number:
907-459-8201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3175 PEGER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99709-5454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-459-1481
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAULSON
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
Authorized Official Title or Position:
EMERGENCY SERVICES ADMINISTRATOR
Authorized Official Telephone Number:
907-459-1481

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0230 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 337474300 . This is a "OWCP" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: TR0508 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590007983 . This is a "MEDICARE RR" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




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