Organization · NPI-2

Alcan Medical Group LLC

Family Medicine · Fairbanks, AK

NPI number1134739485
StatusActive
Last updated in NPPESDec 2, 2021

Details

NPI
1134739485
Entity type
Organization (NPI-2)
Legal business name
Alcan Medical Group LLC
Organization subpart
No
Enumeration date
Aug 2, 2020
Certification date
Dec 2, 2021
Last updated
Dec 2, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes
133VN1201X Dietitian, Registered, Nutrition, Obesity and Weight Management––

Practice location

751 Old Richardson Hwy Ste 203
Fairbanks, AK 99701-7805

Phone 303-472-6424

Mailing address

751 Old Richardson Hwy Ste 101
Fairbanks, AK 99701-7802

Phone 907-328-0844 · Fax 907-328-0843

Authorized official

Casey E Blood
Owner
9073280844

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