NPIMap

Organization Active NPI

Pediatric Resource Center of Alaska

  • Community/Behavioral Health Agency
  • Wasilla, AK
National Provider Identifier
1720600570
Registry record updated May 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PEDIATRIC RESOURCE CENTER OF ALASKA
Practice address
1975 W Church Ridge Dr
Wasilla, AK 99654-2102
Phone
(907) 414-9554
NPI assigned
May 15, 2020
Last updated
May 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2020

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

Authorized official

Name
Marshal PackaNPI 1003434945
Title
Executive Manager
Phone
(907) 414-0203

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

1975 W Church Ridge Dr
Wasilla, AK 99654-2102

Mailing address

1975 W Church Ridge Dr
Wasilla, AK 99654-2102
Phone (907) 414-9554

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1589500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589500800000",
    "number": "1720600570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1975 W CHURCH RIDGE DR",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996542102",
            "telephone_number": "907-414-9554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 W CHURCH RIDGE DR",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996542102",
            "telephone_number": "907-414-9554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC RESOURCE CENTER OF ALASKA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-15",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A",
        "authorized_official_last_name": "PACKA",
        "authorized_official_first_name": "MARSHAL",
        "authorized_official_title_or_position": "EXECUTIVE MANAGER",
        "authorized_official_telephone_number": "907-414-0203"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; 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.