SHANE UDELHOVEN PA-C NPI 1124355359

NPI Information

NPI: 1124355359
Provider Name: SHANE UDELHOVEN, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: RIVER HEALTH AND WELLNESS, LLC

PECOS Registration: Yes

Address:
35670 KENAI SPUR HWY STE 103A
SOLDOTNA, AK
ZIP 99669
Phone: (907) 260-1655
Get Directions

Shane Udelhoven, PA-C is a medical physician assistant in Soldotna, AK with 15 years of experience. Shane Udelhoven, PA-C NPI is 1124355359. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

35670 KENAI SPUR HWY STE 103A
SOLDOTNA, AK
ZIP 99669-649
Phone: (907) 260-1655
Fax: (980) 495-8870

The NPI 1124355359 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

Insertion of needle into vein for collection of blood sample (HCPCS:36415)

The enumeration date for this NPI number is 11/9/2009 and was last updated on 2/18/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	390200000X	Student in an Organized Health Care Education/Training Program				No
2	363AM0700X	Physician Assistant	Medical	PADA893	ALASKA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1572984	MEDICAID	ALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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