Organization
TANANA VALLEY MEDICAL SURGICAL GROUP INC
Active
Other names
Tanana Valley Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES SHILL MBA (CEO)
(907) 459-3509
Entity
Organization
Contact information
Practice address
1001 NOBLE ST, FAIRBANKS, AK 99701-4922
(907) 459-3507
(907) 459-3532
Mailing address
1001 NOBLE ST, FAIRBANKS, AK 99701-4922
(907) 459-3507
(907) 459-3532
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CE7854
MEDICARE RAILROAD
AK
05
—
GR0118
—
AK
Enumeration date
03/02/2006
Last updated
05/24/2012
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