ODYSSEY FAMILY PRACTICE LLC (NPI# 1780142042) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780142042 |
| Entity Type | Organization |
| Organization Name | ODYSSEY FAMILY PRACTICE LLC |
| Practice Address |
11595 Kenai Spur Highway Kenai AK 99611 |
| Mailing Address |
Po Box 922 Kasilof AK 99610-0922 |
| Practice Telephone | 9073134569 |
| Practice Fax Number | 9073134939 |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2020-02-05 |
| Authorized Official Name | JARED LEE WALLACE (OWNER) |
| Authorized Official Telephone | 9073134569 |
| Authorized Official Credential | PA-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QX0100X |
Clinic/Center Specialization: Occupational Medicine |
Ambulatory Health Care Facilities | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
11595 KENAI SPUR HIGHWAY |
| City | KENAI |
| State | AK |
| Zip Code | 99611 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649803099 | Guardian Flight LLC | Ambulance | 145 Granite Point Ct, Kenai, AK 99611 | 2020-02-13 |
| 1104482967 | James Daniel Hudson | Massage Therapist | 601 Frontage Rd Suite 103, Kenai, AK 99611 | 2019-05-16 |
| 1255996351 | Shelly Lynn Niblack | Counselor | 10200, Kenai Sour Hwy, Kenai, AK 99611 | 2019-05-03 |
| 1043793656 | Jerri Ann Chivers | Massage Therapist | 10815 Kenai Spur Highway, Kenai, AK 99611 | 2018-09-10 |
| 1003320060 | Christine G. Morin | Massage Therapist | 1608 Tanga Circle, Kenai, AK 99611 | 2017-11-28 |
| 1013433259 | Amanda Mckinley | Registered Nurse | 630 Barnacle Way Suite A, Kenai, AK 99611 | 2017-08-18 |
| 1780132753 | Kenai Peninsula Imaging Center LLC | Clinic/Center | 100 Trading Bay Rd Ste 7, Kenai, AK 99611 | 2016-09-19 |
| 1376905000 | Savana Long | Licensed Practical Nurse | 1700 Cone Avenue, Kenai, AK 99611 | 2016-03-22 |
| 1477977684 | Jac Enterprises, Inc. | Assisted Living Facility | 701 North Forest Dr, Kenai, AK 99611 | 2014-02-07 |
| 1326460387 | Colleen Mcnulty | Residential Treatment Facility, Physical Disabilities | 701 North Forest St., Kenai, AK 99611 | 2014-01-10 |
| Find all providers in zip 99611 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982176368 | Functional Medicine of Alaska, LLC | Family Medicine | 508 S Willow St Ste C, Kenai, AK 99611-6940 | 2018-12-22 |
| 1447736491 | John Martin Kinsey | Family Medicine | 509 Pine Ave, Kenai, AK 99611-7556 | 2018-07-12 |
| 1043496268 | Samuel Herman Schurig | Family Medicine | 10543 Kenai Spur Highway, Kenai, AK 99611 | 2008-01-17 |
| 1043361629 | Kim Edward Thiele | Family Medicine | 36901 Mallard Rd, Kenai, AK 99611-6434 | 2007-01-12 |
| 1114077468 | Ray Lynn Carlson | Family Medicine | 10543 Kenai Spur Hwy, Kenai, AK 99611-7812 | 2007-01-11 |
| 1609944271 | Kenneth S Hahn | Family Medicine | 11472 Kenai Spur Hwy Ste 2, Kenai, AK 99611-7779 | 2006-12-01 |
| 1316932031 | Terri Lee Elliott | Family Medicine | 135 Bidarka St, Suite 101, Kenai, AK 99611-7741 | 2005-09-19 |
| 1326048414 | Michael Edward Merrick | Family Medicine | 416 Frontage Rd, Suite 400, Kenai, AK 99611-7770 | 2005-07-29 |
| 1124667498 | Independence Healthcare PC | Family Medicine | 100 Trading Bay Rd Ste 8, Kenai, AK 99611-7786 | 2020-01-03 |
| 1346684313 | Robert Byron Mitchell | Family Medicine | 508 Upland St, Kenai, AK 99611 | 2013-04-22 |
| Find all providers in KENAI | ||||
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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.