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KODIAK ISLAND MEDICAL ASSOCIATES LLC NPI 1770529794


NPI Information

NPI: 1770529794
Provider Name: KODIAK ISLAND MEDICAL ASSOCIATES LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 02D2219265

Address:
1818 E REZANOF DR
KODIAK, AK
ZIP 99615
Phone: (907) 486-6065
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KODIAK ISLAND MEDICAL ASSOCIATES LLC is a multi-specialty clinic center in Kodiak, AK. KODIAK ISLAND MEDICAL ASSOCIATES LLC NPI is 1770529794. The provider is registered as an organization entity type.

The provider's business location address is:

1818 E REZANOF DR
KODIAK, AK
ZIP 99615
Phone: (907) 486-6065
Fax: (907) 486-2248

The provider's authorized official is Mark E Withrow .
The authorized official title is Owner and has the following contact phone number (907) 486-6065.

The CLIA number assigned to this NPI record is 02D2219265 - school/student health service with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/20/2006 and was last updated on 12/6/2017.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QM1300XClinic/CenterMulti-SpecialtyYes

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

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