Fairbanks Ultrasound, LLC.
Organization Active NPI Radiology Clinic/Center · Fairbanks, AK
NPI 1235455809 · NPPES record last updated Dec 9, 2010
Key facts
- NPI
- 1235455809
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Radiology Clinic/Center 261QR0200X
- License
- 935916 (AK)
- Legal business name
- FAIRBANKS ULTRASOUND, LLC.
- Practice address
- 3419 Airport Way Ste D
Fairbanks, AK 99709-4761 - Phone
- (907) 474-2002
- Fax
- (907) 474-1622
- NPI assigned
- Apr 7, 2010
- Organization subpart
- No
Authorized official
- Name
- Jeffrey Alan Zuckerman, MD
- Title
- Director
- Phone
- (907) 456-7767
Practitioners 9
-
Janice Pin-Wang Chen, M.D.
-
David L Evans, MD
-
Jessica Ellen Panko, M.D
-
Keir Andrew Bexar Fowler, M.D.
-
William Roice Krueger, D.O.
-
Jordan Ross, M.D.
-
Timothy Ryan, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170706001834 | AK | Part B Supplier - Clinic/Group Practice | 3577745264 |
Receives reassigned benefits from 9 practitioners Practice locations: Fairbanks, AK |
National Provider Directory
Locations
3419 Airport Way
Ste D
Fairbanks, AK 99709
Phone (907) 374-4644
570 Riverstone Way
Ste 2
Fairbanks, AK 99709
Phone (907) 458-8633
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiology Clinic/Center | 261QR0200X | 935916 | AK | Yes |
Addresses
Primary practice location
3419 Airport Way Ste D
Fairbanks, AK 99709-4761
Mailing address
315 Illinois St
Fairbanks, AK 99701-2910
Phone (907) 456-7767
Other providers in Fairbanks, AK
- Fairbanks Resource Agency Inc
- Fairbanks Resource Agency Inc
- Fairbanks Somatic Therapy and Wellness LLC
- Fairbanks Surgery, LLC
- Fairbanks Taxi Services LLC.
- Fairbanks Urology
- Fairbanks Vascular Surgery
- Fairbanks Youth Advocates
- Wade M Falconburg
- Lois Faller
All providers in Fairbanks, AK · Radiology Clinic/Center in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.