Basic Information
| Provider Information | |||||||||
| NPI: | 1538204474 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN HOSPITAL ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 80846 | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997080846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074585178 | ||||||||
| FaxNumber: | 9074585180 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 COWLES ST | ||||||||
| Address2: | SUITE 280 N. TOWER | ||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997015999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074585178 | ||||||||
| FaxNumber: | 9074585180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 05/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | STARKS | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9074585178 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 287420 | AK | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.