Providence Imaging Center

Primary specialty

Mobile Mammography Clinic/CenterTaxonomy code 261QR0207X

License

48375 Issued in AK

Legal business name

PROVIDENCE IMAGING CENTER

Practice address

3340 Providence Dr
Anchorage, AK 99508

Phone

(907) 212-3151

Fax

(907) 212-5828

NPI assigned

Apr 27, 2017

Last updated

May 14, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donald Wayne Anderson Jr.

Title

Assistant Secretary of Enrollments

Phone

(425) 358-9786

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Providence Imaging Center

  • Diagnostic Radiology Physician
  • Anchorage, AK
  • NPI 1528006020

  9335039627

  Same PAC ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carolyn Reyes

  • Maternal & Fetal Medicine Physician
  • Sacramento, CA
  • NPI 1801912928
  NPD (past)

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

{
    "created_epoch": "1493251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747180800000",
    "number": "1265967137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4567",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084567",
            "telephone_number": "907-212-3151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3340 PROVIDENCE DR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "99508",
            "telephone_number": "907-212-3151",
            "fax_number": "907-212-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE IMAGING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-27",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QR0207X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile Mammography",
            "state": "AK",
            "license": "48375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Providence Health & Services Washington (Walter J and Ermalee Hickel House)
• Providence Health & Services- Washington (Providence Medical Group Alaska)
• Providence Health & Services-Washington (Providence Medical Group Alaska)
• Providence Health & Services-Washington (Providence Horizon House)
• Providence Health System Washington (Providence Apothecary)
• Providence Imaging Center
• Providence Surgery Centers LLC (Creekside Surgical Center)
• Ellen Michelle Provost, DO
• Kimberly Pruetting, LMT
• Alexis Victoria Pruitt

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.