NPIMap

Organization Active NPI

Fairweather Deadhorse Medical Clinic

  • Physician Assistant
  • Deadhorse, AK
National Provider Identifier
1508121047
Registry record updated Aug 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
940479 Issued in AK
Legal business name
FAIRWEATHER DEADHORSE MEDICAL CLINIC
Practice address
500 1St Street
Deadhorse, AK 99734-0000
Phone
(907) 685-1800
Fax
(907) 685-1803
NPI assigned
Jul 11, 2012
Last updated
Aug 9, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2013

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

Authorized official

Name
Ms. Amy R Bolam
Title
Group Practice Manager
Phone
(907) 248-8008

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 940479 AK Primary

Addresses

Primary practice location

500 1St Street
Deadhorse, AK 99734-0000

Mailing address

PO Box 200134
Anchorage, AK 99520-0134
Phone (907) 248-8008

National Provider Directory

National Provider Directory
Tax ID family
Fairweather LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376006400000",
    "number": "1508121047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 200134",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995200134",
            "telephone_number": "907-248-8008",
            "fax_number": "907-248-8208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 1ST STREET",
            "city": "DEADHORSE",
            "state": "AK",
            "postal_code": "997340000",
            "telephone_number": "907-685-1800",
            "fax_number": "907-685-1803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRWEATHER DEADHORSE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-11",
        "last_updated": "2013-08-09",
        "status": "A",
        "authorized_official_last_name": "BOLAM",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "GROUP PRACTICE MANAGER",
        "authorized_official_telephone_number": "907-248-8008",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "940479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deadhorse, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2013; 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.