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General NPI Number Information
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NPI Number | 1437224573
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Entity Type | Organization
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Legal Business Name | MOONGANG INC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 1867 AIRPORT WAY STE 130B
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City | FAIRBANKS
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State | AK
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Zip | 99701-4056
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Country | US
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Telephone | 907-452-2178
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Fax | 907-452-3524
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Provider Business Mailing Address
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Address Line | 1867 AIRPORT WAY STE 130B
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City | FAIRBANKS
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State | AK
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Zip | 99701-4056
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Country | US
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Telephone | 907-452-2178
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Fax | 907-452-3524
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEONIE HORSTER DERAMUS
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Credential | MD
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Telephone | 907-452-2178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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