Provider Demographics
NPI:1811063571
Name:ALASKA OPEN IMAGING CENTER LLC
Entity type:Organization
Organization Name:ALASKA OPEN IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:KINION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-357-1220
Mailing Address - Street 1:1751 GARDNER WAY STE B
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6564
Mailing Address - Country:US
Mailing Address - Phone:907-357-1220
Mailing Address - Fax:907-357-1222
Practice Address - Street 1:1751 GARDNER WAY STE B
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6564
Practice Address - Country:US
Practice Address - Phone:907-357-1220
Practice Address - Fax:907-357-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7045932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG1553Medicaid
AKMDG1551Medicaid
AKMDG155Medicaid
AKMDG1552Medicaid
AKN2018OtherBC BS AOIC NUMBER
AKMDG1552Medicaid
AKMDG1551Medicaid