Healthcare Provider Details

I. General information

NPI: 1295513091
Provider Name (Legal Business Name): TANANA CHIEFS CONFERENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W COWLES ST
FAIRBANKS AK
99701-5926
US

IV. Provider business mailing address

122 1ST AVE STE 106
FAIRBANKS AK
99701-4871
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-8251
  • Fax: 907-459-3860
Mailing address:
  • Phone: 907-452-8251
  • Fax: 907-459-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

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