Provider Demographics
NPI:1063466688
Name:ALASKA IMAGING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ALASKA IMAGING ASSOCIATES, LLC
Other - Org Name:NORTHERN LIGHTS IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSEANN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-792-7975
Mailing Address - Street 1:PO BOX 140349
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-0349
Mailing Address - Country:US
Mailing Address - Phone:907-792-7920
Mailing Address - Fax:907-792-7901
Practice Address - Street 1:2751 DEBARR RD STE 360
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-6809
Practice Address - Country:US
Practice Address - Phone:907-792-7920
Practice Address - Fax:907-792-7921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG950Medicaid
AKMDG515Medicaid
AKMDG525Medicaid
CJ7568Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AKMDG515Medicaid