Provider Demographics
NPI:1871332387
Name:TANANA CHIEFS CONFERENCE
Entity type:Organization
Organization Name:TANANA CHIEFS CONFERENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:JACOLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-452-8251
Mailing Address - Street 1:1717 W COWLES ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5926
Mailing Address - Country:US
Mailing Address - Phone:907-452-8251
Mailing Address - Fax:907-459-3830
Practice Address - Street 1:1717 W COWLES ST BLDG B
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5926
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:907-459-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical