Provider Demographics
NPI:1194935320
Name:AUXILIARY ACCOUNTS FOR FMH/DC
Entity type:Organization
Organization Name:AUXILIARY ACCOUNTS FOR FMH/DC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LIFELINE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WHORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-458-5597
Mailing Address - Street 1:1650 COWLES ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5925
Mailing Address - Country:US
Mailing Address - Phone:907-458-5597
Mailing Address - Fax:907-458-5035
Practice Address - Street 1:1650 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5925
Practice Address - Country:US
Practice Address - Phone:907-458-5597
Practice Address - Fax:907-458-5035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMS5935Medicaid