Provider Demographics
NPI:1538204474
Name:NORTHERN HOSPITAL ASSOCIATES LLC
Entity type:Organization
Organization Name:NORTHERN HOSPITAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-458-5178
Mailing Address - Street 1:PO BOX 80846
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-0846
Mailing Address - Country:US
Mailing Address - Phone:907-458-5178
Mailing Address - Fax:907-458-5180
Practice Address - Street 1:1650 COWLES ST
Practice Address - Street 2:SUITE 280 N. TOWER
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5999
Practice Address - Country:US
Practice Address - Phone:907-458-5178
Practice Address - Fax:907-458-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK287420208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
152023Medicare PIN