NPIMap

Organization Active NPI

Fairbanks Memorial Hospital, LLC

  • Community/Retail Pharmacy
  • Fairbanks, AK
National Provider Identifier
1083165740
Registry record updated Oct 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
FAIRBANKS MEMORIAL HOSPITAL, LLC
Practice address
1650 Cowles St
Fairbanks, AK 99701-5907
Phone
(907) 458-5525
NPI assigned
Oct 18, 2016
Last updated
Oct 18, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
FOUNDATION HEALTH, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 18, 2016

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

Authorized official

Name
Shelley D Ebenal
Title
General Counsel
Phone
(907) 458-5550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

1650 Cowles St
Fairbanks, AK 99701-5907

Mailing address

1650 Cowles St
Fairbanks, AK 99701-5907
Phone (907) 458-5525

Other names 1

  • Denali Pharmacy Other name

National Provider Directory

National Provider Directory
Tax ID family
Fairbanks Memorial Hospital LLC7 organizations share this tax ID, including this one
Part of
Foundation Health LLC

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

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.

NPI Registry JSON

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

{
    "created_epoch": "1476748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476748800000",
    "number": "1083165740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 COWLES ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015907",
            "telephone_number": "907-458-5525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COWLES ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015907",
            "telephone_number": "907-458-5525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANKS MEMORIAL HOSPITAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOUNDATION HEALTH, LLC",
        "enumeration_date": "2016-10-18",
        "last_updated": "2016-10-18",
        "status": "A",
        "authorized_official_last_name": "EBENAL",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "GENERAL COUNSEL",
        "authorized_official_telephone_number": "907-458-5550"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Denali Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Oct 18, 2016; 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.