MCKINLEY SPORTS MEDICINE, LLC (NPI# 1407304017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407304017 |
| Entity Type | Organization |
| Organization Name | MCKINLEY SPORTS MEDICINE, LLC |
| Practice Address |
3745 Geist Rd Fairbanks AK 99709-3554 |
| Practice Telephone | 9074563341 |
| Practice Fax Number | 9074563443 |
| Mailing Telephone | 9074563341 |
| Mailing Fax Number | 9074563443 |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2016-09-13 |
| Authorized Official Name | JENNIFER K MALCOLM (PRESIDENT) |
| Authorized Official Telephone | 9074563341 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
10040231 | AK | Allopathic & Osteopathic Physicians |
| Street Address |
3745 GEIST RD |
| City | FAIRBANKS |
| State | AK |
| Zip Code | 99709-3554 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689625964 | Van E Lamore | Physician Assistant | 3745 Geist Rd, Fairbanks, AK 99709-3554 | 2006-05-12 |
| 1740890011 | Shannen Mcnamara | Physician Assistant | 3745 Geist Rd, Fairbanks, AK 99709-3554 | 2020-08-03 |
| 1164082202 | Anders Harbord Carlson | Physical Therapist | 3745 Geist Rd, Fairbanks, AK 99709-3554 | 2019-06-20 |
| 1821516345 | Benjamin Douglas Johnson | Orthopaedic Surgery | 3745 Geist Rd, Fairbanks, AK 99709-3554 | 2017-09-05 |
| 1487172011 | Dayna M Daku | Physician Assistant | 3745 Geist Rd, Fairbanks, AK 99709-3554 | 2017-09-04 |
| 1295184703 | Samantha Paige Smith | Specialist/Technologist | 3745 Geist Rd, Fairbanks, AK 99709 | 2016-06-06 |
| 1295175651 | Neal Everson | Orthopaedic Surgery | 3745 Geist Rd, Fairbanks, AK 99709-3554 | 2013-07-01 |
| 1235448309 | Daniel R Johnson, D.o. | Orthopaedic Surgery | 3745 Geist Rd, Fairbanks, AK 99709-3548 | 2010-10-06 |
| 1144536061 | Ambria Marie Thomas | Physician Assistant | 3745 Geist Rd, Fairbanks, AK 99709-3548 | 2010-08-30 |
| 1801054879 | Jennifer A Holt | Physician Assistant | 3745 Geist Rd, Fairbanks, AK 99709-3554 | 2008-05-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255946810 | Beacon Monitoring Professional Services | Technician, Other | 745 Staffordshire Rd, Fairbanks, AK 99709 | 2020-09-10 |
| 1235629544 | Fairbanks Healing Space | Health Educator | 3875 Geist Road, Suite E #136, Fairbanks, AK 99709 | 2018-05-11 |
| 1609395409 | Shawn K Goggins | Counselor | 1423 Peger Road, Fairbanks, AK 99709 | 2017-09-12 |
| 1710433347 | Jay Titus | Technician/Technologist | 2884 Marina Drive, Fairbanks, AK 99709 | 2016-09-01 |
| 1710391610 | Hannah Summerfelt | Dentist | 3539 Thomas St, Fairbanks, AK 99709 | 2014-06-18 |
| 1629407325 | Diane Louise Mitchell | Nurse Practitioner | 4650 Harvard Cir, Fairbanks, AK 99709 | 2013-11-04 |
| 1407147929 | Christina Martz | Counselor | 1270 Summet Drive, Fairbanks, AK 99709 | 2011-05-02 |
| 1255652285 | Surgery Center of Fairbanks LLC | Clinic/Center | 2310 Peger Road, Fairbanks, AK 99709 | 2010-06-14 |
| 1962661835 | John Leo Hughes Jr Jr. | Dentist | 3437 Airport Way, Suite 205, Fairbanks, AL 99709 | 2008-06-05 |
| 1508042417 | Katherine E Johnson, Md PC | Ophthalmology | 2485 Chief William Drive, Suite 100, Fairbanks, AK 99709 | 2008-01-10 |
| Find all providers in zip 99709 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437487493 | Cindy M. Lee, LLC | Family Medicine | 4100 Lake Otis Pkwy, Suite 206, Anchorage, AK 99508-5229 | 2009-12-02 |
| 1932223047 | Nancy Marie Greenwell | Family Medicine | 3340 Providence Dr, Suite A351, Anchorage, AK 99508-4691 | 2007-03-16 |
| 1942237441 | Mark W Tuccillo | Family Medicine | 103 Fram Street, Petersburg, AK 99833-0589 | 2006-06-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.