NPIMap

Organization Active NPI

Tanana Valley Clinic LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
National Provider Identifier
1922559558
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
1043161 Issued in 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
Last updated
Jul 15, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
FOUNDATION HEALTH LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

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

Authorized official

Name
Anthony G Sudduth
Title
Cfo
Phone
(907) 458-5300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Group Psychotherapy PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP2701X
Multi-Specialty Clinic/Center 261QM1300X 1043161 AK Primary

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

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmdprod.craneware.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other craneware, inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory
Part of
Foundation Health LLC

Locations

1101 Noble St
Fairbanks, AK 99701
Phone (907) 458-2648

1101 Noble St
#1
Fairbanks, AK 99701

1640 Cowles St
Ste 1
Fairbanks, AK 99701
Phone (907) 452-4268

1650 Cowles St
#4
Fairbanks, AK 99701

1650 Cowles St
#H100
Fairbanks, AK 99701

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 219

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 219

NPI Registry JSON

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752537600000",
    "number": "1922559558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73720",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997073720",
            "telephone_number": "907-459-3500",
            "fax_number": "907-459-3526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 NOBLE ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014948",
            "telephone_number": "907-459-3500",
            "fax_number": "907-459-3526"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 Noble St",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997014924",
            "country_code": "US",
            "telephone_number": "907-459-3500",
            "fax_number": "907-458-2628",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2111 Cowles St",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997015918",
            "country_code": "US",
            "telephone_number": "907-459-3500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1919 Lathrop St",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997015937",
            "country_code": "US",
            "telephone_number": "907-459-3500",
            "fax_number": "907-459-3526",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1650 Cowles St",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997015907",
            "country_code": "US",
            "telephone_number": "907-459-3500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TANANA VALLEY CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOUNDATION HEALTH LLC",
        "enumeration_date": "2016-10-19",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A",
        "authorized_official_last_name": "SUDDUTH",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "907-458-5300"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "AK",
            "license": "1043161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmdprod.craneware.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.17.9.1",
            "affiliationName": "craneware, inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "3340 Peachtree Rd NE Ste 850",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303261072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Jul 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.