ODYSSEY FAMILY PRACTICE LLC NPI 1780142042

NPI Information

ODYSSEY FAMILY PRACTICE LLC is a family medicine in Kenai, AK. The provider is 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. ODYSSEY FAMILY PRACTICE LLC NPI is 1780142042. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

11595 KENAI SPUR HIGHWAY
KENAI, AK
ZIP 99611
Phone: (907) 313-4569
Fax: (907) 313-4939

The provider's authorized official is Jared Lee Wallace .
The authorized official title is Owner and has the following contact phone number (907) 313-4569.

The CLIA number assigned to this NPI record is 02D2162874 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/6/2019 and was last updated on 2/5/2020.

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:

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