# SURGERY CENTER OF FAIRBANKS LLC

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

## Provider details

- **NPI number:** 1255652285
- **Authorized official:** DR. MARK A WADE M.D. (OWNER)
- **Authorized official phone:** (907) 479-2663

## Contact information

- **Practice address:** 2310 PEGER ROAD, FAIRBANKS, AK 99709
- **Practice address phone:** (907) 479-2663
- **Mailing address:** 1905 COWLES ST, FAIRBANKS, AK 99701-5914
- **Mailing address phone:** (907) 479-2663

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | AK | Yes |

## Other

- **Enumeration date:** 06/14/2010
- **Last updated:** 11/29/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 929695 | AK BUSINESS LICENSE | AK |
| 01 | — | ASC-013 | HEALTH FACILITIES LICENSING AND CERTIFICATION | AK |