PROVIDENCE IMAGING CENTER (NPI# 1528006020) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528006020 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE IMAGING CENTER |
| Practice Address |
3340 Providence Dr Suite 101 Anchorage AK 99508-4642 |
| Mailing Address |
Po Box 4567 Portland OR 97208-4567 |
| Practice Telephone | 9072123182 |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2019-01-31 |
| Authorized Official Name | MR. DONALD WAYNE ANDERSON JR. (ASST SEC FOR ENROLLMENT/DIR REIMB) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | GR0223 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 17101 Snowmobile Ln Ste 101, Eagle River, AK 995777043 | 9072123151 | 9072125827 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265967137 | Providence Imaging Center | Clinic/Center | 3340 Providence Dr, Anchorage, AK 99508 | 2017-04-27 |
| Street Address |
3340 PROVIDENCE DR SUITE 101 |
| City | ANCHORAGE |
| State | AK |
| Zip Code | 99508-4642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992706865 | Evelyn D Rider | Pediatrics | 3340 Providence Dr, Suite 366, Anchorage, AK 99508-4616 | 2005-08-02 |
| 1265967137 | Providence Imaging Center | Clinic/Center | 3340 Providence Dr, Anchorage, AK 99508 | 2017-04-27 |
| 1053844019 | Stephanie S Fortt | Social Worker | 3340 Providence Dr, Suite A351, Anchorage, AK 99508-4691 | 2017-04-06 |
| 1407306434 | Haven Medical, LLC | Physician Assistant | 3340 Providence Dr, Ste 466, Anchorage, AK 99508-4691 | 2016-10-13 |
| 1962952234 | Megan Hurlburt | Dietitian, Registered | 3340 Providence Dr, Suite 358, Anchorage, AK 99508-4691 | 2016-10-10 |
| 1770968158 | Zachary Johnson | Physician Assistant | 3340 Providence Dr, Suite #a565, Anchorage, AK 99508-4691 | 2015-07-27 |
| 1235478553 | Jessica H Anderson | Physician Assistant | 3340 Providence Dr, Suite 565, Anchorage, AK 99508-4691 | 2013-02-06 |
| 1104174275 | Nicole Kopacz | Nurse Practitioner | 3340 Providence Dr, Suite 452, Anchorage, AK 99508-4691 | 2012-08-21 |
| 1922372598 | Northern Lights Surgical Associates, P.C. | Specialist | 3340 Providence Dr, Suite 363, Anchorage, AK 99508-4691 | 2012-02-29 |
| 1831480151 | Todd Alan Sneesby | Dentist | 3340 Providence Dr, Suite 560, Anchorage, AK 99508-4627 | 2011-04-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366063349 | Alexandra L Davis | Student in an Organized Health Care Education/Training Program | 1202 E 36th Ave, Anchorage, AK 99508 | 2020-05-01 |
| 1366087108 | The Salvation Army, A California Corporation | Community/Behavioral Health | 3600 East 20th Avenue, Anchorage, AK 99508 | 2019-11-15 |
| 1679120349 | Kila Gilcart | Speech-Language Pathologist | 161 Klevin Street #103, Anchorage, AK 99508 | 2019-08-19 |
| 1326692963 | Shannon Maillet | Behavior Technician | 1650 S Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1427602044 | Frank Harris Lawson Iv | Behavior Technician | 1650 S. Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1104470723 | Vivalesi Seforosa Nair | Behavior Technician | 1650 South Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1043864267 | The Cozy Chalet Assisted Living Home LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3707 Mt Blanc Circle, Anchorage, AK 99508 | 2019-07-25 |
| 1942861778 | Christine Mary Hoover | Registered Nurse | Alaska Native Medical Center - Inpatient Pediatrics, 4315 Diplomacy Dr, Anchorage, AK 99508 | 2019-06-24 |
| 1215594502 | Ashley Ongtowasruk | Case Manager/Care Coordinator | 4441 Dipomacy Dr, Suite 500, Anchorage, AK 99508 | 2019-05-22 |
| 1659937019 | Rayne Johnson | Behavior Technician | 4000 San Ernesto Blvd, Anchorage, AK 99508 | 2019-05-11 |
| Find all providers in zip 99508 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386986917 | Elaine Clark Pigman | Radiology | Alaska Radiology Associates, 3650 Piper St. Suite A, Anchorage, AK 99508 | 2013-03-21 |
| 1396011300 | Alexander Glen Wright | Radiology | 3650 Piper Street Ste A, Anchorage, AK 99508 | 2012-03-25 |
| 1669705562 | Matrix Radiology Associates, LLC | Radiology | 2440 E Tudor Rd, #238, Anchorage, AK 99507-1185 | 2009-09-09 |
| 1821103714 | Matthew Vincent Cronin | Radiology | 3801 Debarr Road, Radiology Department, Anchorage, AK 99508 | 2006-08-20 |
| 1063466688 | Alaska Imaging Associates, LLC | Radiology | 2751 Debarr Rd Ste 360, Anchorage, AK 99508-6809 | 2006-05-19 |
| 1174573174 | Imaging Associates, LLC | Radiology | 3650 Piper Street, Suite A, Anchorage, AK 99508 | 2006-05-11 |
| 1154396034 | Yariv Cohen | Radiology | 3650 Piper Street Ste A., Anchorage, AK 99508 | 2006-02-22 |
| 1629049762 | Harold F Cable | Radiology | 2110 E Northern Lights Blvd, Anchorage, AK 99508-4154 | 2006-01-27 |
| 1538159165 | Janice M Anderson | Radiology | 3440 Providence Dr, Anchorage, AK 99508 | 2005-10-25 |
| 1396731238 | Christopher L Kottra | Radiology | 3650 Piper St, Suite A, Anchorage, AK 99508-4692 | 2005-09-26 |
| Find all providers in ANCHORAGE | ||||
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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.