Provider Demographics
NPI:1649314071
Name:ARCTIC INTERNAL MEDICINE, PB
Entity type:Organization
Organization Name:ARCTIC INTERNAL MEDICINE, PB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-452-6610
Mailing Address - Street 1:2009 COWLES ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5916
Mailing Address - Country:US
Mailing Address - Phone:907-452-6610
Mailing Address - Fax:907-452-5754
Practice Address - Street 1:2009 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5916
Practice Address - Country:US
Practice Address - Phone:907-452-6610
Practice Address - Fax:907-452-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMD1621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD16211Medicaid
AK151638Medicare ID - Type UnspecifiedAIMS GROUP #