Pediatric Neurology Clinic of Alaska, P.C.

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

4904 Issued in AK

Legal business name

PEDIATRIC NEUROLOGY CLINIC OF ALASKA, P.C.

Practice address

2401 E 42ND Ave
Suite 306
Anchorage, AK 99508-5228

Phone

(907) 562-6300

Fax

(907) 562-6305

NPI assigned

Jan 9, 2013

Organization subpart

No

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

Authorized official

Name

Roderic Smith III, M.D.

Title

President

Phone

(907) 562-6310

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1357689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357689600000",
    "number": "1164769204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 E 42ND AVE",
            "address_2": "SUITE 306",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085228",
            "telephone_number": "907-562-6300",
            "fax_number": "907-562-6305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 E 42ND AVE",
            "address_2": "SUITE 306",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085228",
            "telephone_number": "907-562-6300",
            "fax_number": "907-562-6305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC NEUROLOGY CLINIC OF ALASKA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-09",
        "last_updated": "2013-01-09",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "RODERIC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-562-6310",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "AK",
            "license": "4904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carly Peckham
• Inaam A Pedalino, DDS
• Veronica Rae Peddada, FNP-BC
• Pediatric Gastroenterology Inc
• Pediatric Gastroenterology of Alaska, LLC
• Pediatric Neuropsychological Services of Alaska, PC
• Pediatric OT Services, LLC
• Pediatric Specialists of Alaska LLC
• David J Pedigo, OD
• Pedro J. Valdes, M.D.

• Medical Specialty Clinic/Center in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Medical Specialty Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2013; 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.