NPIMap

Organization Active NPI

Southeast Alaska Regional Center

  • Clinical Medical Laboratory
  • Palmer, AK
National Provider Identifier
1760458491
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
288794 Issued in AK
Legal business name
SOUTHEAST ALASKA REGIONAL CENTER
Practice address
2490 S Woodworth
Suite 410
Palmer, AK 99645
Phone
(907) 745-9230
Fax
(907) 745-9233
NPI assigned
Feb 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jerald R Scott, MD
Title
Owner
Phone
(907) 622-3569

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 288794 AK Primary

Addresses

Primary practice location

2490 S Woodworth
Suite 410
Palmer, AK 99645

Mailing address

PO Box 241889
Anchorage, AK 99524-1889
Phone (907) 563-1777

Other identifiers 1

IdentifierTypeStateIssuer
MD47212MedicaidAK

Other names 1

  • SEARCH Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
02D0941048Alaska Urology, LLC2490 South Woodworth Loop Suite 401, Palmer, AK 99645Provider-performed microscopyFeb 18, 2028
02D2085811Alaska Urology, LLC2490 S Woodworth Loop # 401, Palmer, AK 99645ComplianceJun 10, 2027

National Provider Directory

National Provider Directory

Locations

2490 S Woodworth Loop
Ste 41
Palmer, AK 99645
Phone (866) 236-8296

2490 S Woodworth Loop
Ste 410
Palmer, AK 99645
Phone (807) 745-8100

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760458491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 241889",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995241889",
            "telephone_number": "907-563-1777",
            "fax_number": "907-561-7464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 S WOODWORTH",
            "address_2": "SUITE 410",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "99645",
            "telephone_number": "907-745-9230",
            "fax_number": "907-745-9233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ALASKA REGIONAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "JERALD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-622-3569",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AK",
            "license": "288794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD47212",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SEARCH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palmer, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.