NPIMap

Organization Active NPI

Fairbanks Memorial Physician Specialities

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
National Provider Identifier
1386763290
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
FAIRBANKS MEMORIAL PHYSICIAN SPECIALITIES
Practice address
1650 Cowles St
Fairbanks, AK 99701-5925
Phone
(907) 452-8181
NPI assigned
Mar 29, 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
Dennis E Dahlen
Title
Sr Vice President
Phone
(602) 747-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

1650 Cowles St
Fairbanks, AK 99701-5925

Mailing address

1441 N 12TH St
Phoenix, AZ 85006-2837

National Provider Directory

National Provider Directory

Member of 1

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

  • Banner Health

    dba Banner Hospice of Northern Colorado

    • Community Based Hospice Care Agency
    • Greeley, CO
    • NPI 1407409964

    Member Of

    NPD member

Locations

1650 Cowles St
Ste 6
Fairbanks, AK 99701
Phone (907) 458-5319

1650 Cowles St
Ste 61A
Fairbanks, AK 99701
Phone (907) 458-5319

Practitioners & affiliated clinicians

Practitioners 33

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.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386763290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 N 12TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COWLES ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015925",
            "telephone_number": "907-452-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANKS MEMORIAL PHYSICIAN SPECIALITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAHLEN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "SR VICE PRESIDENT",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "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.