Provider Demographics
NPI:1568580850
Name:CHEST MEDICINE FAIRBANKS,P.C
Entity Type:Organization
Organization Name:CHEST MEDICINE FAIRBANKS,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:QUIGLEY
Authorized Official - Last Name:HANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-590-0695
Mailing Address - Street 1:PO BOX 71659
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-1659
Mailing Address - Country:US
Mailing Address - Phone:907-456-3750
Mailing Address - Fax:907-451-1701
Practice Address - Street 1:1650 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5998
Practice Address - Country:US
Practice Address - Phone:907-456-3750
Practice Address - Fax:907-451-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1350207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG499Medicaid
AKMDG499Medicaid