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Organization
MINNIE STREET SURGERY CENTER, LLC
Active
Organization
MINNIE STREET SURGERY CENTER, LLC
Active
Other names
Minnie Street Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY L JOHNSON DDS (MEMBER)
(907) 479-8844
Entity
Organization
Contact information
Practice address
114 MINNIE ST STE A, FAIRBANKS, AK 99701-3000
(907) 479-8844
Mailing address
114 MINNIE ST STE A, FAIRBANKS, AK 99701-3000
(907) 479-8844
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UNKNOWN
UNKNOWN
AK
Enumeration date
08/24/2021
Last updated
12/02/2021
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