Organization
FAIRBANKS NORTH STAR BOROUGH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD PAULSON (EMERGENCY SERVICES ADMINISTRATOR)
(907) 459-1481
Entity
Organization
Contact information
Practice address
3175 PEGER RD, FAIRBANKS, AK 99709-5454
(907) 459-1481
Mailing address
PO BOX 71122, FAIRBANKS, AK 99707-1122
(907) 459-8200
(907) 459-8201
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
0230
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
337474300
OWCP
AK
01
—
590007983
MEDICARE RR
AK
05
—
TR0508
—
AK
Enumeration date
05/12/2006
Last updated
08/03/2012
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