TANANA VALLEY CLINIC LLC – Multi-Specialty Clinic/Center, NPI 1922559558
Multi-Specialty Clinic/Center
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for TANANA VALLEY CLINIC LLC
1101 Noble St
Fairbanks, AK 997014924
Phone: (907) 459-3500
Fax: (907) 458-2628
Type: Location
2111 Cowles St
Fairbanks, AK 997015918
Phone: (907) 459-3500
Type: Location
1919 Lathrop St
Fairbanks, AK 997015937
Phone: (907) 459-3500
Fax: (907) 459-3526
Type: Location
1650 Cowles St
Fairbanks, AK 997015907
Phone: (907) 459-3500
Type: Location
1001, Noble Street, South Fairbanks, Fairbanks, Fairbanks North Star, Alaska, 99701, United States
FAIRBANKS, AK 997014948
Phone: (907) 459-3500
Fax: (907) 459-3526
Type: Location
PO BOX 73720
FAIRBANKS, AK 997073720
Phone: (907) 459-3500
Fax: (907) 459-3526
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-08-28
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-12-31 (891 days ago).
Enrollment records
2
Earliest due date
2023-12-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20161228001991 | O | Clinic/Group Practice | AK | 2023-12-31 |
| O20180828000750 | O | Multi-Specialty - Physician | AK | 2026-10-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 99701)
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