Provider Demographics
NPI:1386759470
Name:FAIRBANKS CANCER CARE PHYSICIANS
Entity type:Organization
Organization Name:FAIRBANKS CANCER CARE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-452-4768
Mailing Address - Street 1:1640 COWLES ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5925
Mailing Address - Country:US
Mailing Address - Phone:907-452-4768
Mailing Address - Fax:907-452-1009
Practice Address - Street 1:1640 COWLES ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5925
Practice Address - Country:US
Practice Address - Phone:907-452-4768
Practice Address - Fax:907-452-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK926150207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD6153Medicaid
AKMDG543Medicaid
AKNP7619Medicaid
AKMD14421Medicaid
AKMD69431Medicaid
AKMPG0088Medicaid
AKK160114Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
AKK160112Medicare ID - Type UnspecifiedGROUP NUMBER
AKK160113Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
AKNP7619Medicaid
AKMPG0088Medicaid
AKMD69431Medicaid
AKMD6153Medicaid
AKK162479Medicare PIN
AKK162483Medicare PIN
AKK160115Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
AKK162480Medicare PIN
AKR56962Medicare UPIN
G80242Medicare UPIN
AKK162481Medicare PIN