Fairbanks Vascular Surgery

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

FAIRBANKS VASCULAR SURGERY

Practice address

2485 Chief William Dr Ste 100
Fairbanks, AK 99709-4873

Phone

(907) 328-0965

Fax

(907) 457-5278

NPI assigned

May 16, 2022

Last updated

Jun 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Hardeep Reddick, PA

Title

Owner

Phone

(408) 800-8200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Locations

Practitioners 1

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.

• Milan Bajmoczi, M.D.

  • Vascular Surgery Physician
  • Fairbanks, AK
  • NPI 1700012598
  Medicare reassignment NPD

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

{
    "created_epoch": "1652659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655769600000",
    "number": "1972240562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2485 CHIEF WILLIAM DR STE 100",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997094873",
            "telephone_number": "907-328-0965",
            "fax_number": "907-457-5278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2485 CHIEF WILLIAM DR STE 100",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997094873",
            "telephone_number": "907-328-0965",
            "fax_number": "907-457-5278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANKS VASCULAR SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-16",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A",
        "authorized_official_last_name": "REDDICK",
        "authorized_official_first_name": "HARDEEP",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "408-800-8200",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fairbanks Somatic Therapy and Wellness LLC
• Fairbanks Surgery, LLC
• Fairbanks Taxi Services LLC.
• Fairbanks Ultrasound, LLC.
• Fairbanks Urology
• Fairbanks Youth Advocates (Clearwater Counseling)
• Wade M Falconburg, LCSW, MAC, PACT
• Lois Faller, BS
• Family Centered Services of Ak
• Family Centered Services of Alaska

• Clinic/Center in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; 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.