02D2162874 CLIA NUMBER - ODYSSEY FAMILY PRACTICE, LLC

Laboratory Demographics

  • CLIA Code: 02D2162874
  • Facility Name: ODYSSEY FAMILY PRACTICE, LLC
  • Facility Address: 11595 KENAI SPUR HIGHWAY, STE B
    KENAI, AK
    ZIP 99611
  • Facility Phone: 907 313-4569
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JARED L. WALLACE
  • NPI Number: 1780142042
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 02D2162874
LAB Type Physician Office
Facility Name ODYSSEY FAMILY PRACTICE, LLC
Street 11595 KENAI SPUR HIGHWAY, STE B
City KENAI
State AK
ZIP 99611
Phone 907 313-4569
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2025
Certificate Expiration Date 3/3/2027
Facility Type Physician Office
Lab Director JARED L. WALLACE

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