# TANANA VALLEY MEDICAL SURGICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tanana Valley Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184691743
- **Authorized official:** MR. JAMES SHILL MBA (CEO)
- **Authorized official phone:** (907) 459-3509

## Contact information

- **Practice address:** 1001 NOBLE ST, FAIRBANKS, AK 99701-4922
- **Practice address phone:** (907) 459-3507
- **Practice address fax:** (907) 459-3532
- **Mailing address:** 1001 NOBLE ST, FAIRBANKS, AK 99701-4922
- **Mailing address phone:** (907) 459-3507
- **Mailing address fax:** (907) 459-3532

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/02/2006
- **Last updated:** 05/24/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CE7854 | MEDICARE RAILROAD | AK |
| 05 | — | GR0118 | — | AK |