Basic Information
| Provider Information | |||||||||
| NPI: | 1821201278 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TANANA CHIEFS CONFERENCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 1ST AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997014848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074528251 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1717 W COWLES ST | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997015926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074516682 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | BERGSTROM | ||||||||
| AuthorizedOfficialFirstName: | JACOLINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF HEALTH SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 9074528251 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 261QI0500X | N | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | 261QX0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Oncology | 324500000X | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.