Odessa Medical Clinic, PC
Organization Active NPI Family Medicine Physician · Odessa, MO
NPI 1023224904 · NPPES record last updated Aug 9, 2023
Key facts
- NPI
- 1023224904
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- DOR9F95 (MO)
- Legal business name
- ODESSA MEDICAL CLINIC, PC
- Practice address
- 408 N. 4TH St
Suite B
Odessa, MO 64076-1646 - Phone
- (816) 230-8777
- Fax
- (816) 230-8855
- NPI assigned
- May 15, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Bradley L Zink, DO
- Title
- Physician Owner
- Phone
- (816) 230-8777
Practitioners 2
-
Jessica L Smith, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051227000530 | MO | Part B Supplier - Clinic/Group Practice | 9335161819 |
Receives reassigned benefits from 2 practitioners Practice locations: Odessa, MO |
National Provider Directory
Locations
408 N 4th St
Ste B
Odessa, MO 64076
Phone (816) 230-8777
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | DOR9F95 | MO | Yes |
Addresses
Primary practice location
408 N. 4TH St
Suite B
Odessa, MO 64076-1646
Mailing address
408 N. 4TH St
Suite B
Odessa, MO 64076-1646
Phone (816) 230-8777
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12844049 | Other | MO | BCBSKC INDIVIDUAL PROV |
| 31334013 | Other | MO | BCBSKC GRP NUMBER |
| M140000 | Other | MO | MEDICARE GROUP NUMBER |
Other names
- Bradley L Zink DO
Other providers in Odessa, MO
- Odessa Eye Care LLC
- Odessa Family Dental, LLC
- Odessa Family Pharmacy
- Odessa Fire & Rescue Protection District
- Odessa Health Care Center, L.L.C.
- Odessa Pediatric Dental Care
- Odessa SNF Opco LLC
- Emmaline Owen
- Carrie Parrish
- Linda Lou Proctor
All providers in Odessa, MO · Family Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.