# FIRESIDE FAMILY MEDICINE LLC

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

## Provider details

- **NPI number:** 1831702455
- **Authorized official:** DR. BART WORTHINGTON MD (OWNER)
- **Authorized official phone:** (606) 234-5183

## Contact information

- **Practice address:** 2957 SANTA PATRICIA CT, NORTH POLE, AK 99705-6138
- **Practice address phone:** (907) 385-0257
- **Practice address fax:** (907) 385-0249
- **Mailing address:** 2957 SANTA PATRICIA CT, NORTH POLE, AK 99705-6138
- **Mailing address phone:** (907) 385-0257
- **Mailing address fax:** (907) 385-0249

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/24/2020
- **Last updated:** 08/20/2021