Healthcare Provider Details

I. General information

NPI: 1417155987
Provider Name (Legal Business Name): ADVANCED SONOGRAMS OF ALASKA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 LAKE OTIS PKWY SUITE 103
ANCHORAGE AK
99508-5215
US

IV. Provider business mailing address

PO BOX 142502
ANCHORAGE AK
99514-2502
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-3111
  • Fax: 907-562-3136
Mailing address:
  • Phone: 907-562-3111
  • Fax: 907-562-3136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT F PICKETT
Title or Position: OWNER
Credential:
Phone: 907-562-3111