# FAIRBANKS MEMORIAL CARDIOLOGY CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FOUNDATION HEALTH, LLC
- **Other names:** Fairbanks Memorial Physician Specialties
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1942751631
- **Legal business name:** FOUNDATION HEALTH, LLC
- **Authorized official:** SHELLEY D EBENAL (GENERAL COUNSEL)
- **Authorized official phone:** (907) 458-5550

## Contact information

- **Practice address:** 1650 COWLES ST DEPT 61A, FAIRBANKS, AK 99701-5907
- **Practice address phone:** (907) 458-6453
- **Mailing address:** 1650 COWLES ST DEPT 61A, FAIRBANKS, AK 99701-5907
- **Mailing address phone:** (907) 458-6453

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/18/2016
- **Last updated:** 10/18/2016