KODIAK ISLAND MEDICAL ASSOCIATES LLC (NPI# 1609051986) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609051986 |
| Entity Type | Organization |
| Organization Name | KODIAK ISLAND MEDICAL ASSOCIATES LLC |
| Practice Address |
1818 E Rezanof Dr Kodiak AK 99615 |
| Practice Telephone | 9074866065 |
| Practice Fax Number | 9074862248 |
| Mailing Telephone | 9074866065 |
| Mailing Fax Number | 9074862248 |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2008-01-04 |
| Authorized Official Name | MARK E WITHROW (OWNER MD) |
| Authorized Official Telephone | 9074866065 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770529794 | Kodiak Island Medical Associates LLC | Clinic/Center | 1818 E Rezanof Dr, Kodiak, AK 99615 | 2006-06-20 |
| Street Address |
1818 E REZANOF DR |
| City | KODIAK |
| State | AK |
| Zip Code | 99615 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417920497 | Mark Edward Withrow | General Practice | 1818 E Rezanof Dr, Kodiak, AK 99615 | 2006-02-09 |
| 1548366891 | Jeremy Todd Larson | Family Medicine | 1818 E Rezanof Dr, Kodiak, AK 99615 | 2006-09-15 |
| 1770529794 | Kodiak Island Medical Associates LLC | Clinic/Center | 1818 E Rezanof Dr, Kodiak, AK 99615 | 2006-06-20 |
| 1174591325 | Carol Juergens | Internal Medicine | 1818 E Rezanof Dr, Kodiak, AK 99615 | 2006-03-14 |
| 1225004401 | Stephen Spencer Burnside | Internal Medicine | 1818 E Rezanof Dr, Kodiak, AK 99615 | 2006-02-27 |
| 1093788994 | Rae Jean Blaschka | Nurse Practitioner | 1818 E Rezanof Dr, Kodiak, AK 99615-6505 | 2006-02-10 |
| 1538132519 | Greg Joseph Mete Sr. | Physician Assistant | 1818 E Rezanof Dr, Kodiak, AK 99615 | 2006-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144864232 | Linda Irene Dunlap | Spec/Tech, Pathology | 1915 E. Remanof Drive, Kodiak, AK 99615 | 2019-10-31 |
| 1639638190 | Stephanie Brenteson | Community Health Worker | 125 Airport Way, Akhiok, AK 99615 | 2019-03-14 |
| 1609351022 | Desiree Alexis Wheeler | Optometrist | 3450 E Rezanof Dr, Kodiak, AK 99615 | 2018-10-02 |
| 1417479072 | Elaine Loomis Olsen | Case Manager/Care Coordinator | 1111 Purtov St., Kodiak, AK 99615 | 2017-07-14 |
| 1750828414 | Mary Jean Francisco | Case Manager/Care Coordinator | 717 East Rezanof Drive, Kodiak, AK 99615 | 2017-01-19 |
| 1558818112 | Carolyn Hawes | Case Manager/Care Coordinator | 717 Rezanof Dr, Kodiak, AK 99615 | 2016-09-01 |
| 1285083683 | Amanda Wilson | Community Health Worker | 124 Akhiok Street, Akhiok, AK 99615 | 2016-06-07 |
| 1447612056 | Kailee Champion | Massage Therapist | 3449 Rezanof Drive East, Kodiak, AK 99615 | 2016-03-23 |
| 1376891069 | Krystyna Mcrobert | Technician, Other | Cape Sarichef Road Bldg N46, Rockmore King Clinic, Kodiak, AK 99615 | 2012-08-28 |
| 1164778619 | Mark Anthony Johnson | Pharmacist | 3449 Rezanof Drive, Kodiak, AK 99615 | 2012-08-01 |
| Find all providers in zip 99615 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558899807 | Arctic Chiropractic and Physical Medicine Kodiak | Clinic/Center | 2975 Mill Bay Rd Ste A, Kodiak, AK 99615-7831 | 2017-05-31 |
| 1770529794 | Kodiak Island Medical Associates LLC | Clinic/Center | 1818 E Rezanof Dr, Kodiak, AK 99615 | 2006-06-20 |
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| 1811420391 | Southcentral Foundation | Clinic/Center | 1021 E 3rd Ave, Anchorage, AK 99501-6102 | 2017-04-11 |
| 1942751631 | Fairbanks Memorial Cardiology Clinic, LLC | Clinic/Center | 1650 Cowles St Dept 61a, Fairbanks, AK 99701-5907 | 2016-10-18 |
| 1689021776 | Southcentral Foundation | Clinic/Center | 755 A St, Anchorage, AK 99501-3625 | 2016-05-18 |
| 1194152058 | Peninsula Pediatric Therapy, Inc. | Clinic/Center | 7335 Palmer Wasilla Hwy, Palmer, AK 99645-6007 | 2013-10-08 |
| 1154591451 | La Integrative Primary Care Centre Inc | Clinic/Center | 8811 Toloff St, Anchorage, AK 99507-3848 | 2008-03-03 |
| 1962572099 | Juneau Family Birth Center | Clinic/Center | 3225 Hospital Dr Unit 106, Juneau, AK 99801-7863 | 2006-11-08 |
| 1912954272 | Southcentral Foundation | Clinic/Center | 101 Airport Road, Iliamna, AK 99606 | 2006-05-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.