Organization
FAIRBANKS CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TONY NIMEH MD (OWNER)
(617) 686-6809
Entity
Organization
Contact information
Practice address
1405 KELLUM ST STE 201, FAIRBANKS, AK 99701-4189
(907) 452-1761
(844) 531-0274
Mailing address
607 OLD STEESE HWY STE B307, FAIRBANKS, AK 99701-3163
(907) 452-1761
(844) 531-0274
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
4311
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1004328
—
AK
Enumeration date
04/06/2007
Last updated
12/10/2020
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