Minnie Street Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MINNIE STREET SURGERY CENTER, LLC

Practice address

114 Minnie St Ste a
Fairbanks, AK 99701-3000

Phone

(907) 479-8844

NPI assigned

Aug 24, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Gregory L Johnson, DDSNPI 1376571521

Title

Member

Phone

(907) 479-8844

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Minnie Street Surgery Center Doing business as

Electronic endpoints 1

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

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gregory Lee Johnson, D.D.S

  • Pediatric Dentistry
  • Fairbanks, AK
  • NPI 1376571521
  NPD Authorized official

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638403200000",
    "number": "1497422919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 MINNIE ST STE A",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997013000",
            "telephone_number": "907-479-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 MINNIE ST STE A",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997013000",
            "telephone_number": "907-479-8844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNIE STREET SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-24",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "907-479-8844",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNKNOWN",
            "identifier": "UNKNOWN",
            "state": "AK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drj@minniestreetsc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "114 Minnie St Ste A",
            "city": "Fairbanks",
            "state": "AK",
            "country_code": "US",
            "postal_code": "997013000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Minnie Street Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cornelius Lee Mingo Jr.
• Carrie L Miniard, LCSW
• Lydia Mink
• Deborah J Minnick-Shearin, D.O.
• Minnie Street Children'S Dentistry, PC
• Mary A Minor, ND
• Kimberly Ann Minton
• Roxana Mirabal, D.M.D
• Maritza Dionne Miranda 08/29/8708
• Veronica Mishler

• 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 Dec 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.