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General NPI Number Information
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NPI Number | 1255092896
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Entity Type | Organization
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Legal Business Name | FAIRBANKS MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 01/05/2022
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 1650 COWLES ST
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City | FAIRBANKS
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State | AK
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Zip | 99701-5907
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Country | US
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Telephone | 907-458-5597
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 COWLES ST
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City | FAIRBANKS
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State | AK
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Zip | 99701-5907
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Country | US
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Telephone | 907-458-5597
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | GARY RODERICK
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Credential |
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Telephone | 907-458-3310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333300000X
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Taxonomy Name | Emergency Response System Companies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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