Organization
TANANA VALLEY CLINIC LLC
Active
Parent organization
FOUNDATION HEALTH LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOUNDATION HEALTH LLC
Authorized official
STEPHEN PAUL LESLIE (CFO)
(907) 458-3310
Entity
Organization
Contact information
Practice address
570 RIVERSTONE WAY, FAIRBANKS, AK 99709-2940
(907) 459-3500
Mailing address
PO BOX 73720, FAIRBANKS, AK 99707-3720
(907) 459-3500
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1656221
—
AK
Enumeration date
11/05/2018
Last updated
11/05/2018
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