NPIMap

Organization Active NPI

Tanana Valley Clinic LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
National Provider Identifier
1073081485
Registry record updated Nov 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
TANANA VALLEY CLINIC LLC
Practice address
570 Riverstone Way
Fairbanks, AK 99709-2940
Phone
(907) 459-3500
NPI assigned
Nov 5, 2018
Last updated
Nov 5, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
FOUNDATION HEALTH LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 5, 2018

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

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

570 Riverstone Way
Fairbanks, AK 99709-2940

Mailing address

PO Box 73720
Fairbanks, AK 99707-3720
Phone (907) 459-3500

Other identifiers 1

IdentifierTypeStateIssuer
1656221MedicaidAK

National Provider Directory

National Provider Directory
Part of
Foundation Health LLC

Locations

570 Riverstone Way
Fairbanks, AK 99709
Phone (907) 458-8633

Ownership & related parties

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.

Practitioners & affiliated clinicians

Practitioners 202

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 202

NPI Registry JSON

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

{
    "created_epoch": "1541376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541376000000",
    "number": "1073081485",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 RIVERSTONE WAY",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997092940",
            "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": "2018-11-05",
        "last_updated": "2018-11-05",
        "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": "1656221",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.