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Organization
SURGERY CENTER OF FAIRBANKS LLC
Active
Organization
SURGERY CENTER OF FAIRBANKS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK A WADE M.D. (OWNER)
(907) 479-2663
Entity
Organization
Contact information
Practice address
2310 PEGER ROAD, FAIRBANKS, AK 99709
(907) 479-2663
Mailing address
1905 COWLES ST, FAIRBANKS, AK 99701-5914
(907) 479-2663
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
929695
AK BUSINESS LICENSE
AK
01
—
ASC-013
HEALTH FACILITIES LICENSING AND CERTIFICATION
AK
Enumeration date
06/14/2010
Last updated
11/29/2010
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