Organization
TANANA VALLEY CLINIC LLC
Active
Parent organization
FOUNDATION HEALTH LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOUNDATION HEALTH LLC
Authorized official
ANTHONY G SUDDUTH (CFO)
(907) 458-5300
Entity
Organization
Contact information
Practice address
1001 NOBLE ST, FAIRBANKS, AK 99701-4948
(907) 459-3500
(907) 459-3526
Mailing address
PO BOX 73720, FAIRBANKS, AK 99707-3720
(907) 459-3500
(907) 459-3526
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
1043161
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1656211
—
AK
05
—
1656231
—
AK
05
—
1656237
—
AK
05
—
1680751
—
AK
05
—
1740002
—
AK
Enumeration date
10/19/2016
Last updated
07/15/2025
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