Interior Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

304642 Issued in AK

Legal business name

INTERIOR MEDICAL SUPPLY LLC

Doing business as

Interior Medical Supply

Practice address

915 30TH Ave
Ste 106
Fairbanks, AK 99701-7577

Phone

(907) 457-8486

NPI assigned

Nov 9, 2006

Last updated

Jun 2, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tracy Lynn Ingraham

Title

Owner

Phone

(907) 457-8486

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Interior Medical Supply Doing business as

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212364800000",
    "number": "1295805810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 30TH AVE",
            "address_2": "STE 106",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997017577",
            "telephone_number": "907-457-8486",
            "fax_number": "907-457-8488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 30TH AVE",
            "address_2": "STE 106",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997017577",
            "telephone_number": "907-457-8486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERIOR MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2008-06-02",
        "status": "A",
        "authorized_official_last_name": "INGRAHAM",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-457-8486"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AK",
            "license": "304642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MS3444",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Interior Medical Supply",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Interior Birthing Center LLC
• Interior Community Health Center
• Interior Community Health Center
• Interior Community Health Center Dental Prog
• Interior Eye Center, LLC
• Interior Mobility Systems LLC
• Interior Mobility Systems, LLC (Ims)
• Interior Women's Health, LLC
• Rosalia Ioane
• Christina Marie Ireton, LCSW

• Durable Medical Equipment & Medical Supplies in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Durable Medical Equipment & Medical Supplies in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; 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.