| Fairbanks Memorial Cardiology Center, Llc | |
|
1650 Cowles St Dept 60a Fairbanks AK 99701-5907 | |
| (907) 458-5525 | |
| Not Available |
| Full Name | Fairbanks Memorial Cardiology Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1650 Cowles St Dept 60a, Fairbanks, Alaska |
| Authorized Official Name and Position | Anthony G Suduth (CFO) |
| Authorized Official Contact | 9074583310 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairbanks Memorial Cardiology Center, Llc 1650 Cowles St Dept 60a Fairbanks AK 99701-5907 Ph: (907) 458-5525 | Fairbanks Memorial Cardiology Center, Llc 1650 Cowles St Dept 60a Fairbanks AK 99701-5907 Ph: (907) 458-5525 |
| NPI Number | 1386193472 |
|---|---|
| Provider Enumeration Date | 09/29/2016 |
| Last Update Date | 04/14/2026 |
| Medicare PECOS PAC ID | 0244511269 |
|---|---|
| Medicare Enrollment ID | O20170106000686 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386193472 | NPI | - | NPPES |
| 1656021 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | (* (Not Available)) | Secondary |
| Provider Name | Jean M Tsigonis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972570604 PECOS PAC ID: 1759286750 Enrollment ID: I20060627000029 |
| Provider Name | Richard A Anschuetz |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1386669174 PECOS PAC ID: 3870492689 Enrollment ID: I20060725000041 |
| Provider Name | Romel C Wrenn |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1255302717 PECOS PAC ID: 6608964358 Enrollment ID: I20120522001048 |
| Provider Name | Michael David Kenner |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1417912460 PECOS PAC ID: 4082632849 Enrollment ID: I20120627000280 |
| Provider Name | Debra C Booysen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760935365 PECOS PAC ID: 1355638362 Enrollment ID: I20160919002447 |
| Provider Name | Joseph D Grimes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811356330 PECOS PAC ID: 3577842186 Enrollment ID: I20170118001799 |
| Provider Name | April Jane Dunlevy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861745283 PECOS PAC ID: 6002192762 Enrollment ID: I20170411002538 |
| Provider Name | Cristiane Kaufmann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215375340 PECOS PAC ID: 9032409396 Enrollment ID: I20170707002986 |
| Provider Name | Lee Pierson |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1215103528 PECOS PAC ID: 3173836004 Enrollment ID: I20190520001029 |
| Provider Name | Rodney Badger |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1003874439 PECOS PAC ID: 2567418494 Enrollment ID: I20200721002230 |
| Provider Name | David Jinich |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1861447500 PECOS PAC ID: 3173419132 Enrollment ID: I20220308001802 |
| Provider Name | Mark Ombrellaro |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1699793968 PECOS PAC ID: 1951290535 Enrollment ID: I20231103002214 |
| Provider Name | Bishoy Elbebawy |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1093176901 PECOS PAC ID: 9931494051 Enrollment ID: I20231215000451 |
| Provider Name | Kari Gondeck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750571188 PECOS PAC ID: 8729171244 Enrollment ID: I20231220003407 |
| Provider Name | Walter F Kerwin |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1457397556 PECOS PAC ID: 7012916158 Enrollment ID: I20240112000729 |
| Provider Name | David Kovar |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1770536179 PECOS PAC ID: 9638151400 Enrollment ID: I20240223002732 |
| Provider Name | Michael D Eisenhauer |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1821064510 PECOS PAC ID: 3476678996 Enrollment ID: I20240913000730 |
| Provider Name | Kyle Clark Kimbal |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1104205442 PECOS PAC ID: 6406137504 Enrollment ID: I20241120001112 |
| Provider Name | Anthony Katras |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1124012109 PECOS PAC ID: 1557585007 Enrollment ID: I20241120002078 |
| Provider Name | Mitchell Md Cahn |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1164461331 PECOS PAC ID: 0648162966 Enrollment ID: I20241120002322 |
| Provider Name | Miroslaw Sochanski |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1568447076 PECOS PAC ID: 4688697535 Enrollment ID: I20250130000451 |
| Provider Name | Christina Sparks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215601695 PECOS PAC ID: 4385042712 Enrollment ID: I20250409001073 |
| Provider Name | Hanna Konarzewska |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1316936982 PECOS PAC ID: 3173504032 Enrollment ID: I20250528002785 |
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