Healthcare Provider Details

I. General information

NPI: 1629287958
Provider Name (Legal Business Name): TANANA CHIEFS CONFERENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 1ST AVE SUITE 600
FAIRBANKS AK
99701-4803
US

IV. Provider business mailing address

122 1ST AVE SUITE 600
FAIRBANKS AK
99701-4803
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-8251
  • Fax:
Mailing address:
  • Phone: 907-452-8251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACOLINE BERGSTROM
Title or Position: HS DIRECTOR
Credential:
Phone: 907-452-8251