# FAIRBANKS CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073636148
- **Authorized official:** DR. TONY NIMEH MD (OWNER)
- **Authorized official phone:** (617) 686-6809

## Contact information

- **Practice address:** 1405 KELLUM ST STE 201, FAIRBANKS, AK 99701-4189
- **Practice address phone:** (907) 452-1761
- **Practice address fax:** (844) 531-0274
- **Mailing address:** 607 OLD STEESE HWY STE B307, FAIRBANKS, AK 99701-3163
- **Mailing address phone:** (907) 452-1761
- **Mailing address fax:** (844) 531-0274

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 4311 | AK | Yes |

## Other

- **Enumeration date:** 04/06/2007
- **Last updated:** 12/10/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1004328 | — | AK |