NPIMap

Organization Active NPI

Fairbanks Clinic Inc

  • Clinic/Center
  • Fairbanks, AK
National Provider Identifier
1073636148
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
4311 Issued in AK
Legal business name
FAIRBANKS CLINIC INC
Practice address
1405 Kellum St Ste 201
Fairbanks, AK 99701-4189
Phone
(907) 452-1761
Fax
(844) 531-0274
NPI assigned
Apr 6, 2007
Last updated
Dec 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Authorized official

Name
Dr. Tony Nimeh, MDNPI 1760804777
Title
Owner
Phone
(617) 686-6809

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 4311 AK Primary

Addresses

Primary practice location

1405 Kellum St Ste 201
Fairbanks, AK 99701-4189

Mailing address

607 Old Steese Hwy Ste B307
Fairbanks, AK 99701-3163
Phone (907) 452-1761

Other identifiers 1

IdentifierTypeStateIssuer
1004328MedicaidAK

National Provider Directory

National Provider Directory

Locations

607 Old Steese Hwy
Ste B307
Fairbanks, AK 99701

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1073636148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 OLD STEESE HWY STE B307",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997013163",
            "telephone_number": "907-452-1761",
            "fax_number": "844-531-0274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 KELLUM ST STE 201",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014189",
            "telephone_number": "907-452-1761",
            "fax_number": "844-531-0274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANKS CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A",
        "authorized_official_last_name": "NIMEH",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-686-6809",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AK",
            "license": "4311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1004328",
            "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 Dec 10, 2020; 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.