NPIMap

Organization Active NPI

Laser Vein Center of Fairbanks, LLC

  • Primary Care Clinic/Center
  • Fairbanks, AK
National Provider Identifier
1124161716
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
903255 Issued in AK
Legal business name
LASER VEIN CENTER OF FAIRBANKS, LLC
Practice address
506 Gaffney Rd
Suite 300
Fairbanks, AK 99701-4914
Phone
(907) 452-8346
Fax
(907) 451-8346
NPI assigned
Feb 14, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Donald Ives, MDNPI 1356316699
Title
Manager
Phone
(907) 452-8346

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 903255 AK Primary

Addresses

Primary practice location

506 Gaffney Rd
Suite 300
Fairbanks, AK 99701-4914

Mailing address

PO Box 440
Ester, AK 99725-0440

National Provider Directory

National Provider Directory

Locations

2550 Denali St
Ste 1307
Anchorage, AK 99503
Phone (907) 375-8787

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124161716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 440",
            "city": "ESTER",
            "state": "AK",
            "postal_code": "997250440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 GAFFNEY RD",
            "address_2": "SUITE 300",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014914",
            "telephone_number": "907-452-8346",
            "fax_number": "907-451-8346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASER VEIN CENTER OF FAIRBANKS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "IVES",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "907-452-8346",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AK",
            "license": "903255",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Aug 22, 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.