Tanana Valley Clinic LLC
Organization Active NPI Multi-Specialty Clinic/Center · Fairbanks, AK
NPI 1922559558 · NPPES record last updated Jul 15, 2025
Key facts
- NPI
- 1922559558
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- License
- 1043161 (AK)
- Legal business name
- TANANA VALLEY CLINIC LLC
- Practice address
- 1001 Noble St
Fairbanks, AK 99701-4948 - Phone
- (907) 459-3500
- Fax
- (907) 459-3526
- NPI assigned
- Oct 19, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- FOUNDATION HEALTH LLC
Authorized official
- Name
- Anthony G Sudduth
- Title
- Cfo
- Phone
- (907) 458-5300
Parent organization (reported in NPPES) 1
Practitioners 219
-
Brian G Accola, M.D.
-
Muhammad K Ahmed, MD
-
Stephen D Ake, D.O.
-
Kathryn Baker, MSN, FNP-C
-
Kendrick David Blais, D.O.
-
Nicole Cherie Bonfoey, CRNA
-
Todd Capistrant, D.O.
-
Emery J Chang, MD
-
Ciara Lynn Chen, MD
-
Katherine Clawson, CRNA
-
Lori D Conklin, M.D.
-
Christopher Cowley, CRNA
-
Dayna M Daku, PA-C
-
Herbert Day, D.O.
-
Porsche Dehut, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161228001991 | AK | Part B Supplier - Clinic/Group Practice | 5698056901 |
Receives reassigned benefits from 187 practitioners Practice locations: Fairbanks, AK |
| O20180828000750 | AK | DME Supplier - Multi-Specialty - Physician | 5698056901 | Practice locations: Fairbanks, AK |
National Provider Directory
- Part of
- Foundation Health LLC
Locations
1101 Noble St
Fairbanks, AK 99701
Phone (907) 458-2648
1650 Cowles St
#4
Fairbanks, AK 99701
1650 Cowles St
#H100
Fairbanks, AK 99701
1101 Noble St
#1
Fairbanks, AK 99701
1640 Cowles St
Ste 1
Fairbanks, AK 99701
Phone (907) 452-4268
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Group Psychotherapy Psychologist |
103TP2701X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | 1043161 | AK | Yes |
Addresses
Primary practice location
1001 Noble St
Fairbanks, AK 99701-4948
Mailing address
PO Box 73720
Fairbanks, AK 99707-3720
Phone (907) 459-3500
Other practice location 1
1101 Noble St
Fairbanks, AK 99701-4924
Phone (907) 459-3500
Other practice location 2
2111 Cowles St
Fairbanks, AK 99701-5918
Phone (907) 459-3500
Other practice location 3
1919 Lathrop St
Fairbanks, AK 99701-5937
Phone (907) 459-3500
Other practice location 4
1650 Cowles St
Fairbanks, AK 99701-5907
Phone (907) 459-3500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1680751 | Medicaid | AK | |
| 1656231 | Medicaid | AK | |
| 1656211 | Medicaid | AK | |
| 1656237 | Medicaid | AK | |
| 1740002 | Medicaid | AK |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmdprod.craneware.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | craneware, inc |
Other providers in Fairbanks, AK
- Tanana Valley Clinic
- Tanana Valley Clinic LLC
- Tanana Valley Clinic LLC
- Tanana Valley Clinic LLC
- Tanana Valley Clinic LLC
- Tanana Valley Medical Surgical Group Inc
- Tananachiefs Conference, Inc.
- Daniel Allen Tanner
- Jennifer Lynn Tanner
- Natalie Tanner
All providers in Fairbanks, AK · Multi-Specialty Clinic/Center in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.