Organization
INTERIOR MEDICAL SUPPLY LLC
Active
Other names
Interior Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY LYNN INGRAHAM (OWNER)
(907) 457-8486
Entity
Organization
Contact information
Practice address
915 30TH AVE, STE 106, FAIRBANKS, AK 99701-7577
(907) 457-8486
Mailing address
915 30TH AVE, STE 106, FAIRBANKS, AK 99701-7577
(907) 457-8486
(907) 457-8488
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
304642
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MS3444
—
AK
Enumeration date
11/09/2006
Last updated
06/02/2008
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