Surgery Center of Fairbanks LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SURGERY CENTER OF FAIRBANKS LLC

Practice address

2310 Peger Road
Fairbanks, AK 99709

Phone

(907) 479-2663

NPI assigned

Jun 14, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Mark A Wade, M.D.NPI 1356307458

Title

Owner

Phone

(907) 479-2663

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Listed as

Surgery Center of Fairbanks LLCCCN 02C0001012

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Interior Alaska Orthopedic & Sports Medicine Inc

  • Specialist
  • Fairbanks, AK
  • NPI 1386815678

  Member Of

  NPD member

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.

• Mark Alan Wade, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Fairbanks, AK
  • NPI 1356307458
  Authorized official Same address or phone
• Timothy Walter Teslow, MD

  • Surgery Physician
  • Fairbanks, AK
  • NPI 1841321890
  NPD (past)

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

{
    "created_epoch": "1276473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290988800000",
    "number": "1255652285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 COWLES ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015914",
            "telephone_number": "907-479-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 PEGER ROAD",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99709",
            "telephone_number": "907-479-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY CENTER OF FAIRBANKS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-14",
        "last_updated": "2010-11-29",
        "status": "A",
        "authorized_official_last_name": "WADE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-479-2663",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "AK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AK BUSINESS LICENSE",
            "identifier": "929695",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH FACILITIES LICENSING AND CERTIFICATION",
            "identifier": "ASC-013",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jackie Sunnyboy
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• Josuhan Suriel
• Sarah Susalla
• Stephen H Sutley, D.D.S.
• Meghan Renne Swafford
• Laura Jean Swanson, RN

• Ambulatory Surgical Clinic/Center in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Ambulatory Surgical Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.