Provider Demographics
NPI:1760665012
Name:NICK SARRIMANOLIS, M.D. LLC
Entity type:Organization
Organization Name:NICK SARRIMANOLIS, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SARRIMANOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-451-1174
Mailing Address - Street 1:1867 AIRPORT WAY STE 145B
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4055
Mailing Address - Country:US
Mailing Address - Phone:907-451-1174
Mailing Address - Fax:907-451-1173
Practice Address - Street 1:1867 AIRPORT WAY STE 145B
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4055
Practice Address - Country:US
Practice Address - Phone:907-451-1174
Practice Address - Fax:907-451-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK4668OtherAK STATE LICENSE
AKMD42851Medicaid
AK153038Medicare PIN
AKMD42851Medicaid