Kodiak Board Certified Radiology, LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

6152 Issued in AK

Legal business name

KODIAK BOARD CERTIFIED RADIOLOGY, LLC

Practice address

1915 E Rezanof Dr
Kodiak, AK 99615-6602

Phone

(907) 486-9581

Fax

(907) 486-9523

NPI assigned

Feb 15, 2011

Organization subpart

No

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

Authorized official

Name

Kay E. Bias

Title

Executive Director

Phone

(907) 565-8005

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1297728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299542400000",
    "number": "1295032910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3427 E TUDOR RD STE A",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995071282",
            "telephone_number": "907-563-3679",
            "fax_number": "907-563-9070"
        },
        {
            "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": "907-486-9581",
            "fax_number": "907-486-9523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KODIAK BOARD CERTIFIED RADIOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-15",
        "last_updated": "2011-03-08",
        "status": "A",
        "authorized_official_last_name": "BIAS",
        "authorized_official_first_name": "KAY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "907-565-8005"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AK",
            "license": "6152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Diagnostic Radiology Physician in Kodiak, AK
• Providers in Kodiak, AK by specialty
• Diagnostic Radiology Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2011; 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.