Kodiak Life Diagnostic Imaging, Inc

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

106389 Issued in AK

Legal business name

KODIAK LIFE DIAGNOSTIC IMAGING, INC

Practice address

1915 E Rezanof Dr
Kodiak, AK 99615-6602

Phone

(907) 512-9559

NPI assigned

Oct 13, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. James Darryl Bise, DO

Title

President

Phone

(907) 512-9559

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507852800000",
    "number": "1083125355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8790",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "996158790",
            "telephone_number": "907-512-9559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 E REZANOF DR",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "996156602",
            "telephone_number": "907-512-9559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KODIAK LIFE DIAGNOSTIC IMAGING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-13",
        "last_updated": "2017-10-13",
        "status": "A",
        "authorized_official_last_name": "BISE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "DARRYL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-512-9559",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "AK",
            "license": "106389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kodiak Island Family Dentistry
• Kodiak Island Health Care Foundation (Kodiak Community Health Center)
• Kodiak Island Health Care Foundation (Kodiak Community Health Center Pharmacy)
• Kodiak Island Medical Associates LLC
• Kodiak Island Medical Associates LLC
• Kodiak Vision Clinic & Sally's Eyeland, Inc.
• John M Koller, M.D.
• Alicia Kostelecky
• Ashley Krimmel, RN, BSN
• Janna Lacroix

• Radiology Clinic/Center in Kodiak, AK
• Providers in Kodiak, AK by specialty
• Radiology Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.