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General NPI Number Information
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NPI Number | 1245456557
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Entity Type | Organization
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Legal Business Name | FAIRBANKS COMMUNITY IMAGING, LLC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1314 22ND AVE.
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City | FAIRBANKS
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State | AK
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Zip | 99701
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Country | US
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Telephone | 907-563-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 LAKE OTIS PKWY STE 309
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City | ANCHORAGE
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State | AK
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Zip | 99508-5231
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JOHN MCCORMICK
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Credential | M.D.
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Telephone | 907-563-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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