| Tanana Valley Clinic Llc | |
|
1001 Noble St Fairbanks AK 99701-4948 | |
| (907) 459-3500 | |
| (907) 459-3526 |
| Full Name | Tanana Valley Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1001 Noble St, Fairbanks, Alaska |
| Authorized Official Name and Position | Anthony G Sudduth (CFO) |
| Authorized Official Contact | 9074585300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tanana Valley Clinic Llc Po Box 73720 Fairbanks AK 99707-3720 Ph: (907) 459-3500 | Tanana Valley Clinic Llc 1001 Noble St Fairbanks AK 99701-4948 Ph: (907) 459-3500 |
| NPI Number | 1922559558 |
|---|---|
| Provider Enumeration Date | 10/19/2016 |
| Last Update Date | 10/02/2023 |
| Medicare PECOS PAC ID | 5698056901 |
|---|---|
| Medicare Enrollment ID | O20161228001991 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922559558 | NPI | - | NPPES |
| 1680751 | Medicaid | AK | |
| 1740002 | Medicaid | AK | |
| 1656211 | Medicaid | AK | |
| 1656231 | Medicaid | AK | |
| 1656237 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 1043161 (Alaska) | Primary |
| Provider Name | Todd A Capistrant |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1710931613 PECOS PAC ID: 2961301635 Enrollment ID: I20040102000245 |
| Provider Name | Bruce M Footit |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760602866 PECOS PAC ID: 2264406271 Enrollment ID: I20040825000406 |
| Provider Name | Cary S Keller |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1992817175 PECOS PAC ID: 2769374214 Enrollment ID: I20040915000263 |
| Provider Name | Michael D Swenson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891761201 PECOS PAC ID: 5698743904 Enrollment ID: I20040923000409 |
| Provider Name | Mark Simon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043207533 PECOS PAC ID: 3678474491 Enrollment ID: I20050117000563 |
| Provider Name | Heather Powers |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1801240221 PECOS PAC ID: 1254382971 Enrollment ID: I20050209000924 |
| Provider Name | Gina Pender |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194790345 PECOS PAC ID: 4385692714 Enrollment ID: I20050418000332 |
| Provider Name | Mishelle A Nace |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1306811559 PECOS PAC ID: 7517905490 Enrollment ID: I20050421000030 |
| Provider Name | Herbert A Day |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609841006 PECOS PAC ID: 2860422235 Enrollment ID: I20050816000291 |
| Provider Name | William W Quirk |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1306866686 PECOS PAC ID: 6305865262 Enrollment ID: I20051121000399 |
| Provider Name | Ellen L Young |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760408850 PECOS PAC ID: 7517981244 Enrollment ID: I20060120000769 |
| Provider Name | James Timothy Foote |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1033184023 PECOS PAC ID: 4880599869 Enrollment ID: I20060626000324 |
| Provider Name | Charles Steiner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558337741 PECOS PAC ID: 9133024128 Enrollment ID: I20060627000023 |
| Provider Name | Jean M Tsigonis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972570604 PECOS PAC ID: 1759286750 Enrollment ID: I20060627000029 |
| Provider Name | Corrine S Leistikow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417922774 PECOS PAC ID: 8921010489 Enrollment ID: I20060627000044 |
| Provider Name | Mary Beth Gannett |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1750356747 PECOS PAC ID: 9335151893 Enrollment ID: I20060627000096 |
| Provider Name | David M Witham |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1457328197 PECOS PAC ID: 4082527635 Enrollment ID: I20060627000167 |
| Provider Name | Barbara J Creighton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902943137 PECOS PAC ID: 1254411200 Enrollment ID: I20080103000606 |
| Provider Name | Brian G Accola |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447236823 PECOS PAC ID: 5395643878 Enrollment ID: I20080904000705 |
| Provider Name | Zachary R Werle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962524355 PECOS PAC ID: 8527153956 Enrollment ID: I20081015000077 |
| Provider Name | Mark R Miles |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1598792384 PECOS PAC ID: 6204737570 Enrollment ID: I20081203000568 |
| Provider Name | Grayson T Westfall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487847828 PECOS PAC ID: 8426081555 Enrollment ID: I20090723000314 |
| Provider Name | Laura S Brunner |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1184770778 PECOS PAC ID: 0941354153 Enrollment ID: I20090821000187 |
| Provider Name | James Francis Leavey |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1861557449 PECOS PAC ID: 1153304191 Enrollment ID: I20100602000721 |
| Provider Name | Melany Kirschen Grogan |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1699968891 PECOS PAC ID: 1153516943 Enrollment ID: I20101105000674 |
| Provider Name | Eric L Schneider |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093826554 PECOS PAC ID: 4587859160 Enrollment ID: I20101109000458 |
| Provider Name | Kendrick D Blais |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497771109 PECOS PAC ID: 4880688605 Enrollment ID: I20101201001410 |
| Provider Name | Stephanie A Ranft |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851608822 PECOS PAC ID: 6406044080 Enrollment ID: I20101227000032 |
| Provider Name | Brittany B Stepovich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174830673 PECOS PAC ID: 5991984965 Enrollment ID: I20110121001030 |
| Provider Name | Peter John Dillon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083819460 PECOS PAC ID: 1456532902 Enrollment ID: I20110216001183 |
| Provider Name | April H Charpentier |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1861437337 PECOS PAC ID: 1052324092 Enrollment ID: I20110330001005 |
| Provider Name | Jed R Weight |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194980680 PECOS PAC ID: 4789856220 Enrollment ID: I20111005000844 |
| Provider Name | Jeffrey A Banks |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1083699300 PECOS PAC ID: 5890961981 Enrollment ID: I20111220000184 |
| Provider Name | Nicole C Bonfoey |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1639449796 PECOS PAC ID: 5193985844 Enrollment ID: I20120404000576 |
| 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 | Vanessa A Venezia Heuer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851360838 PECOS PAC ID: 9739333709 Enrollment ID: I20130129000609 |
| Provider Name | Wendell O. Eames |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902816820 PECOS PAC ID: 4688618457 Enrollment ID: I20130212000128 |
| Provider Name | Terry A Bateman |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1417170580 PECOS PAC ID: 0840445276 Enrollment ID: I20130308000389 |
| Provider Name | Kerry Wappett |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1982846267 PECOS PAC ID: 1254573108 Enrollment ID: I20130806000671 |
| Provider Name | Bethany V Chernich |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1598950545 PECOS PAC ID: 5496998858 Enrollment ID: I20130904000360 |
| Provider Name | Joseph Charles Livengood |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1518948447 PECOS PAC ID: 4688568181 Enrollment ID: I20130905000268 |
| Provider Name | Dante M Conley |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1649389503 PECOS PAC ID: 0749424083 Enrollment ID: I20130926000346 |
| Provider Name | Celine M Clift |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1598081606 PECOS PAC ID: 3971731902 Enrollment ID: I20140120000303 |
| Provider Name | Christopher B Cowley |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1104255892 PECOS PAC ID: 1850517723 Enrollment ID: I20140729002908 |
| Provider Name | Richard Sheridan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548425465 PECOS PAC ID: 0941515118 Enrollment ID: I20150817002684 |
| Provider Name | Mindy L Treybal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336389360 PECOS PAC ID: 5698891539 Enrollment ID: I20150930000047 |
| Provider Name | Cynthia Dennis |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1477765899 PECOS PAC ID: 6507174836 Enrollment ID: I20151006000934 |
| Provider Name | Dennis Mckevitt |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1073585303 PECOS PAC ID: 5193770899 Enrollment ID: I20151012000987 |
| Provider Name | Claire M Stoltz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780948026 PECOS PAC ID: 3274786587 Enrollment ID: I20151103001380 |
| Provider Name | Catherine K Hompesch |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265792410 PECOS PAC ID: 5395031512 Enrollment ID: I20160914000413 |
| Provider Name | Anne R Hanley |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1841556602 PECOS PAC ID: 7012134661 Enrollment ID: I20161026002244 |
| Provider Name | Ashley Lundgren Strum |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467795146 PECOS PAC ID: 9234434275 Enrollment ID: I20161026002673 |
| Provider Name | Owen W Hanley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164789442 PECOS PAC ID: 5092959627 Enrollment ID: I20161101001143 |
| Provider Name | Mary J Joy |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1649618059 PECOS PAC ID: 9234417882 Enrollment ID: I20161102000353 |
| Provider Name | Muhammad K Ahmed |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1457316051 PECOS PAC ID: 6406836642 Enrollment ID: I20161115000540 |
| Provider Name | Nicholas P Cosentino |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013276898 PECOS PAC ID: 1456675099 Enrollment ID: I20170419001752 |
| Provider Name | Cristiane Kaufmann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215375340 PECOS PAC ID: 9032409396 Enrollment ID: I20170707002986 |
| Provider Name | Summer S Engler Jager |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1871852319 PECOS PAC ID: 5799921896 Enrollment ID: I20170710003019 |
| Provider Name | Daniel Curns |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215344916 PECOS PAC ID: 0941571798 Enrollment ID: I20170811002945 |
| Provider Name | Gregory Wood |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1629077961 PECOS PAC ID: 8224086632 Enrollment ID: I20171115000347 |
| Provider Name | Stewart M Kerr |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1932157732 PECOS PAC ID: 8921271560 Enrollment ID: I20180123000749 |
| Provider Name | Robert Foster Greenwood |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356638068 PECOS PAC ID: 1456652601 Enrollment ID: I20180417002607 |
| Provider Name | Jennifer Ribar |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1023492642 PECOS PAC ID: 6406101021 Enrollment ID: I20180621001649 |
| Provider Name | Nathaniel James Buffington |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316028947 PECOS PAC ID: 1456379593 Enrollment ID: I20180804000025 |
| Provider Name | Roxanne Claire Mcmorris |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811255920 PECOS PAC ID: 6002190766 Enrollment ID: I20181221001521 |
| Provider Name | Nora T Quiason |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306852017 PECOS PAC ID: 9234263823 Enrollment ID: I20181226000802 |
| Provider Name | Lance Russell Dunlop |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457452674 PECOS PAC ID: 8224165113 Enrollment ID: I20190307001317 |
| Provider Name | Kristin Ann Flowers |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1356647051 PECOS PAC ID: 1052534864 Enrollment ID: I20190501002650 |
| Provider Name | Lee Moschler Pierson |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1215103528 PECOS PAC ID: 3173836004 Enrollment ID: I20190520001029 |
| Provider Name | Sergei Robinson |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1740672708 PECOS PAC ID: 6002120854 Enrollment ID: I20190614000887 |
| Provider Name | Amber N Figueroa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689768905 PECOS PAC ID: 1254222821 Enrollment ID: I20190717003249 |
| Provider Name | Carla Michelle Cartagena De Jesus |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1518312453 PECOS PAC ID: 1658662788 Enrollment ID: I20190903001727 |
| Provider Name | Sally Jane Mangum |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912351917 PECOS PAC ID: 3476847674 Enrollment ID: I20191003000911 |
| Provider Name | Kathleen Doris Senecal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235561127 PECOS PAC ID: 7113359308 Enrollment ID: I20191108000724 |
| Provider Name | Robert Matthew Monberg |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1679548747 PECOS PAC ID: 1254763469 Enrollment ID: I20191108001544 |
| Provider Name | Julia Franklin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225486228 PECOS PAC ID: 5092147975 Enrollment ID: I20191114001084 |
| Provider Name | Androcles J Lester |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1154740157 PECOS PAC ID: 0446470157 Enrollment ID: I20200225001940 |
| Provider Name | Irina D. Lapshina |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1558639658 PECOS PAC ID: 2466615794 Enrollment ID: I20200304000648 |
| Provider Name | Gwendolyn Lieb |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1750709978 PECOS PAC ID: 0648583690 Enrollment ID: I20200326003373 |
| Provider Name | Jessie Allen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1528321643 PECOS PAC ID: 0648589804 Enrollment ID: I20200526001988 |
| Provider Name | Jayme Schroeder |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1215466081 PECOS PAC ID: 0345679882 Enrollment ID: I20200818002441 |
| Provider Name | Daniel Rohlf |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396127098 PECOS PAC ID: 2769794676 Enrollment ID: I20200924001551 |
| Provider Name | Amy Vagedes |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1699193318 PECOS PAC ID: 3476855982 Enrollment ID: I20201016000888 |
| Provider Name | Stephanie L Willet |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1023375292 PECOS PAC ID: 6709151699 Enrollment ID: I20201208001641 |
| Provider Name | Allan Louis Long |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1770533317 PECOS PAC ID: 3274945456 Enrollment ID: I20201211000692 |
| Provider Name | Gisella P Puga |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1417285032 PECOS PAC ID: 9830234707 Enrollment ID: I20210105002610 |
| Provider Name | Melanie Chapman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174827133 PECOS PAC ID: 1254510647 Enrollment ID: I20210120003296 |
| Provider Name | Anthony Bonitatibus |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1689606477 PECOS PAC ID: 1456255124 Enrollment ID: I20210126000836 |
| Provider Name | Kyle D Aemisegger |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1740488741 PECOS PAC ID: 6305003500 Enrollment ID: I20210209002448 |
| Provider Name | Eric T Fiedler |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437516903 PECOS PAC ID: 3577817907 Enrollment ID: I20210428002240 |
| Provider Name | Julie E Mosley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780150326 PECOS PAC ID: 6800130568 Enrollment ID: I20210505000669 |
| Provider Name | Michelle R Floyd |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1245327576 PECOS PAC ID: 1355343039 Enrollment ID: I20210903001921 |
| Provider Name | Daniel Kechker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225522857 PECOS PAC ID: 9234474859 Enrollment ID: I20210924001299 |
| Provider Name | Lauren Doerfler |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1861854093 PECOS PAC ID: 0345507513 Enrollment ID: I20211005002512 |
| Provider Name | Margaret Whitehead |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1083190474 PECOS PAC ID: 1658615745 Enrollment ID: I20211021000922 |
| Provider Name | Curea Sallee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891254413 PECOS PAC ID: 3971994419 Enrollment ID: I20211217000411 |
| Provider Name | Anthony Mustovich |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1437590759 PECOS PAC ID: 5092009241 Enrollment ID: I20220111002037 |
| Provider Name | Reza Voosoughi |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1851516264 PECOS PAC ID: 4587759642 Enrollment ID: I20220118002520 |
| Provider Name | Brandon Michael Bilka |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1316300304 PECOS PAC ID: 6002208147 Enrollment ID: I20220121001123 |
| Provider Name | Tyson Rutledge |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1740564400 PECOS PAC ID: 6406021179 Enrollment ID: I20220322001262 |
| Provider Name | Lisa Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417697780 PECOS PAC ID: 8426436478 Enrollment ID: I20220602001453 |
| Provider Name | Keegan Mcafee |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1427554740 PECOS PAC ID: 5092062067 Enrollment ID: I20220720003522 |
| Provider Name | Katherine Clawson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1003554056 PECOS PAC ID: 7618352741 Enrollment ID: I20220909002467 |
| Provider Name | Hyrum Lee Judd |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1871952036 PECOS PAC ID: 4880951375 Enrollment ID: I20220913003827 |
| Provider Name | Brynn E Ehlers Jaschen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1649763129 PECOS PAC ID: 8921408576 Enrollment ID: I20220915003549 |
| Provider Name | Savannah C Cahill |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1003442294 PECOS PAC ID: 8224413950 Enrollment ID: I20220916001448 |
| Provider Name | Stephanie Lois Leong |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033190822 PECOS PAC ID: 2466829080 Enrollment ID: I20221110000720 |
| Provider Name | Jeri Rosenbloom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134844749 PECOS PAC ID: 4183092695 Enrollment ID: I20221114003033 |
| Provider Name | Shane Richard Smith |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1063137677 PECOS PAC ID: 3870962574 Enrollment ID: I20221219001645 |
| Provider Name | Ian K Brimhall |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1467652875 PECOS PAC ID: 5799858452 Enrollment ID: I20221219002894 |
| Provider Name | Neil Hurd |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1487703997 PECOS PAC ID: 1850484429 Enrollment ID: I20230120002068 |
| Provider Name | Sarah Ellis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720385412 PECOS PAC ID: 9133359227 Enrollment ID: I20230222002804 |
| Provider Name | Vuth-channy Chhor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295352706 PECOS PAC ID: 5092139824 Enrollment ID: I20230224002070 |
| Provider Name | Dionne Lashawn Montgomery |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1821677600 PECOS PAC ID: 4587037296 Enrollment ID: I20230228001662 |
| Provider Name | Ariana Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992410237 PECOS PAC ID: 1254706195 Enrollment ID: I20230407000564 |
| Provider Name | Joseph Durso |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1356876924 PECOS PAC ID: 5193099885 Enrollment ID: I20230410000858 |
| Provider Name | Megan Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205227097 PECOS PAC ID: 5597084509 Enrollment ID: I20230526002418 |
| Provider Name | David Harries |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1104924109 PECOS PAC ID: 1052304599 Enrollment ID: I20230721000864 |
| Provider Name | Mariah Ann Minder |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1902369077 PECOS PAC ID: 0840654893 Enrollment ID: I20230911001174 |
| Provider Name | George Robert Dulabon |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1649264680 PECOS PAC ID: 4789789322 Enrollment ID: I20230918004139 |
| Provider Name | Stefanie A Lai |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1518429083 PECOS PAC ID: 3870917321 Enrollment ID: I20231006002337 |
| Provider Name | Manuel Alejandro Guerrero |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1548380488 PECOS PAC ID: 7719032465 Enrollment ID: I20231009001516 |
| Provider Name | Ashley Ellsworth Call |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1255575056 PECOS PAC ID: 0042665143 Enrollment ID: I20231010001669 |
| Provider Name | Heather May Hudson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205619772 PECOS PAC ID: 9638525868 Enrollment ID: I20231025000436 |
| Provider Name | Tiffany Borbon |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1760019665 PECOS PAC ID: 3577986058 Enrollment ID: I20231109000117 |
| Provider Name | Stefan Leo-nyquist |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114414265 PECOS PAC ID: 3971852377 Enrollment ID: I20231109000642 |
| Provider Name | Justin G Perdue |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336709989 PECOS PAC ID: 3173970365 Enrollment ID: I20231109001347 |
| Provider Name | James Vodvarka |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1518955210 PECOS PAC ID: 9335191600 Enrollment ID: I20231120000912 |
| Provider Name | Brenda Susan Murphy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407630734 PECOS PAC ID: 6002266780 Enrollment ID: I20231220003834 |
| Provider Name | Jaime Nicole Ringstad |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942862149 PECOS PAC ID: 2860835915 Enrollment ID: I20240206003049 |
| Provider Name | Cindy D Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164299178 PECOS PAC ID: 4385087816 Enrollment ID: I20240212002093 |
Polar Wind Medical Center, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1867 Airport Way Ste 140a, Fairbanks, AK 99701 Phone: 907-457-9355 Fax: 907-457-9356 | |
Alaska Occupational Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1919 Lathrop St Ste 203, Fairbanks, AK 99701 Phone: 907-456-2825 Fax: 907-451-0742 | |
University Of Alaska Fairbanks Center For Health & Counseling Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 612 N. Chandalar Dr., Fairbanks, AK 99775 Phone: 907-474-7043 Fax: 907-474-5777 | |
Joseph Daniel Grimes Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1650 Cowles St, Fairbanks, AK 99701 Phone: 907-458-3345 | |
Linda L Garcia Md Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1405 Kellum St Ste 201, Fairbanks, AK 99701 Phone: 907-378-8119 Fax: 907-488-5539 | |
Tanana Valley Clinic Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1101 Noble St, Fairbanks, AK 99701 Phone: 907-459-3500 | |
Tanana Valley Clinic Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1405 Kellum St, Fairbanks, AK 99701 Phone: 907-459-3500 |