NPIMap

Organization Active NPI

Northern Lights Pain Management LLC

  • Pain Medicine (Anesthesiology) Physician
  • Fairbanks, AK
National Provider Identifier
1619203585
Registry record updated Oct 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
297874 Issued in AK
Legal business name
NORTHERN LIGHTS PAIN MANAGEMENT LLC
Practice address
1320 22ND Ave
Fairbanks, AK 99701-6516
Phone
(907) 452-4777
Fax
(907) 452-4787
NPI assigned
Oct 27, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2009

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

Authorized official

Name
Dr. Robert Valentz, MD
Title
Owner
Phone
(907) 770-9600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X 297874 AK Primary

Addresses

Primary practice location

1320 22ND Ave
Fairbanks, AK 99701-6516

Mailing address

PO Box 71434
Fairbanks, AK 99707-1434
Phone (907) 770-9600

Other identifiers 1

IdentifierTypeStateIssuer
297874OtherAKAK BUSINESS LICENSE

National Provider Directory

National Provider Directory

Locations

2310 Peger Rd
Ste 104
Fairbanks, AK 99709
Phone (907) 452-2947

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1256601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256601600000",
    "number": "1619203585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 71434",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997071434",
            "telephone_number": "907-770-9600",
            "fax_number": "907-277-2629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 22ND AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997016516",
            "telephone_number": "907-452-4777",
            "fax_number": "907-452-4787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LIGHTS PAIN MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-27",
        "last_updated": "2009-10-27",
        "status": "A",
        "authorized_official_last_name": "VALENTZ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-770-9600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "AK",
            "license": "297874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AK BUSINESS LICENSE",
            "identifier": "297874",
            "state": "AK"
        }
    ],
    "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 Oct 27, 2009; 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.