Provider Demographics
NPI:1720039076
Name:FAIRBANKS NORTH STAR BOROUGH
Entity Type:Organization
Organization Name:FAIRBANKS NORTH STAR BOROUGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMERGENCY SERVICES ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-459-1481
Mailing Address - Street 1:PO BOX 71122
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-1122
Mailing Address - Country:US
Mailing Address - Phone:907-459-8200
Mailing Address - Fax:907-459-8201
Practice Address - Street 1:3175 PEGER RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5454
Practice Address - Country:US
Practice Address - Phone:907-459-1481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK02303416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK337474300OtherOWCP
AKTR0508Medicaid
AK590007983OtherMEDICARE RR
AKTR0508Medicaid