Healthcare Provider Details

I. General information

NPI: 1265470298
Provider Name (Legal Business Name): FAIRBANKS MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 GILLAM WAY
FAIRBANKS AK
99701-6056
US

IV. Provider business mailing address

1441 N 12TH ST
PHOENIX AZ
85006-2837
US

V. Phone/Fax

Practice location:
  • Phone: 907-458-5410
  • Fax: 907-458-5412
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DENNIS E DAHLEN
Title or Position: SR VICE PRESIDENT FINANCE
Credential:
Phone: 602-747-4000