Tanana Valley Clinic LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

TANANA VALLEY CLINIC LLC

Practice address

1405 Kellum St
Fairbanks, AK 99701-4189

Phone

(907) 459-3500

NPI assigned

Nov 6, 2018

Last updated

Nov 6, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

FOUNDATION HEALTH LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stephen Paul Leslie

Title

Cfo

Phone

(907) 458-3310

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Foundation Health LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Foundation Health LLC

  dba Denali Pharmacy

  • Community/Retail Pharmacy
  • Fairbanks, AK
  • NPI 1306952247
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541462400000",
    "number": "1073081287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73720",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997073720",
            "telephone_number": "907-459-3500",
            "fax_number": "907-459-3526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 KELLUM ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014189",
            "telephone_number": "907-459-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANANA VALLEY CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOUNDATION HEALTH LLC",
        "enumeration_date": "2018-11-06",
        "last_updated": "2018-11-06",
        "status": "A",
        "authorized_official_last_name": "LESLIE",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "907-458-3310"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1656193",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tanana Chiefs Conference
• Tanana Chiefs Conference, Inc. (TCC)
• Tanana Transportation LLC.
• Tanana Valley Clinic
• Tanana Valley Clinic LLC
• Tanana Valley Clinic LLC
• Tanana Valley Clinic LLC
• Tanana Valley Clinic LLC
• Tanana Valley Medical Surgical Group Inc (Tanana Valley Clinic)
• Tananachiefs Conference, Inc.

• Multi-Specialty Clinic/Center in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Multi-Specialty Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.