Organization
MINNIE STREET SURGERY CENTER, LLC
Active
Other names
Minnie Street Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY L JOHNSON DDS (MEMBER)
(907) 479-8844
Entity
Organization
Contact information
Practice address
114 MINNIE ST STE A, FAIRBANKS, AK 99701-3000
(907) 479-8844
Mailing address
114 MINNIE ST STE A, FAIRBANKS, AK 99701-3000
(907) 479-8844
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UNKNOWN
UNKNOWN
AK
Enumeration date
08/24/2021
Last updated
12/02/2021
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