Healthcare Provider Details

I. General information

NPI: 1487737284
Provider Name (Legal Business Name): INTERIOR WOMEN'S HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 LATHROP ST STE. 205
FAIRBANKS AK
99701-5930
US

IV. Provider business mailing address

1919 LATHROP ST STE. 205
FAIRBANKS AK
99701-5930
US

V. Phone/Fax

Practice location:
  • Phone: 907-479-7701
  • Fax: 907-479-7718
Mailing address:
  • Phone: 907-479-7701
  • Fax: 907-479-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number297091
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number297091
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number297091
License Number StateAK

VIII. Authorized Official

Name: DR. KARL BRUNO BAURICK
Title or Position: OWNER
Credential: M.D.
Phone: 907-479-7701