02D2025663 CLIA NUMBER - FULL SPECTRUM PEDIATRICS, PC

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Laboratory Demographics

CLIA Number: 02D2025663

Facility Name: FULL SPECTRUM PEDIATRICS, PC

Facility Address:
2925 DEBARR ROAD, SUITE 125
ANCHORAGE, AK
ZIP 99508
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Facility Phone Number: 907 677-1864

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1639463953

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	02D2025663
LAB Type	Physician Office
Facility Name	FULL SPECTRUM PEDIATRICS, PC
Street	2925 DEBARR ROAD, SUITE 125
City	ANCHORAGE
State	AK
ZIP	99508
Phone	907 677-1864
CertificateType	4
CertificateEffectiveDate	6/14/2023
CertificateExpirationDate	6/13/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024