02D1024455 CLIA NUMBER - ANCHORAGE PEDIATRIC GROUP, LLC

Laboratory Demographics

  • CLIA Code: 02D1024455
  • Facility Name: ANCHORAGE PEDIATRIC GROUP, LLC
  • Facility Address: 3340 PROVIDENCE DRIVE SUITE 500
    ANCHORAGE, AK
    ZIP 99508
  • Facility Phone: 907 562-2423
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHARLES RYAN, MD
  • NPI Number: 1538192513
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 02D1024455
LAB Type Physician Office
Facility Name ANCHORAGE PEDIATRIC GROUP, LLC
Street 3340 PROVIDENCE DRIVE SUITE 500
City ANCHORAGE
State AK
ZIP 99508
Phone 907 562-2423
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2024
Certificate Expiration Date 4/12/2026
Facility Type Physician Office
Lab Director CHARLES RYAN, MD

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This page was last updated on: 9/29/2025