Provider Demographics
NPI:1023435021
Name:FAR NORTH SURGERY AND SURGICAL ONCOLOGY PC
Entity type:Organization
Organization Name:FAR NORTH SURGERY AND SURGICAL ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MADHU
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-276-3676
Mailing Address - Street 1:PO BOX 75060
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-5060
Mailing Address - Country:US
Mailing Address - Phone:907-276-3676
Mailing Address - Fax:907-276-3679
Practice Address - Street 1:2925 DEBARR ROAD
Practice Address - Street 2:SUITE D350
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2959
Practice Address - Country:US
Practice Address - Phone:907-276-3676
Practice Address - Fax:907-276-3679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty