Provider Demographics
NPI:1689304982
Name:ORTHOPEDIC & SPORTSMEDICINE CLINIC OF FAIRBANKS LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPORTSMEDICINE CLINIC OF FAIRBANKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:907-479-2663
Mailing Address - Street 1:2310 PEGER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5305
Mailing Address - Country:US
Mailing Address - Phone:907-479-2663
Mailing Address - Fax:907-479-2691
Practice Address - Street 1:2310 PEGER RD STE 105
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5305
Practice Address - Country:US
Practice Address - Phone:907-479-2663
Practice Address - Fax:907-479-2691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty