Odland Family Practice Clinic, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

955730 Issued in AK

Legal business name

ODLAND FAMILY PRACTICE CLINIC, LLC

Practice address

950 E Bogard Rd
Suite 234
Wasilla, AK 99654-7184

Phone

(907) 355-0850

Fax

(907) 373-0117

NPI assigned

Mar 26, 2013

Last updated

Mar 26, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shannon Pendergrass, CMRS

Title

Billing Manager

Phone

(907) 355-0850

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364256000000",
    "number": "1114269313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 E BOGARD RD",
            "address_2": "SUITE 234",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996879481",
            "telephone_number": "907-355-0850",
            "fax_number": "907-373-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 E BOGARD RD",
            "address_2": "SUITE 234",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547184",
            "telephone_number": "907-355-0850",
            "fax_number": "907-373-0117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODLAND FAMILY PRACTICE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-26",
        "last_updated": "2013-03-26",
        "status": "A",
        "authorized_official_last_name": "PENDERGRASS",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "907-355-0850",
        "authorized_official_credential": "CMRS"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "955730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD9857",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD1574",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer O'Keefe
• Shauna O'Pharrow-Johnson, RBT
• Summer O'Shea Hutchins, CARE COORDINATOR
• Brittany Oaks, LPC
• Monica Ockwig, BA, CC
• Duane I Odland, DO
• Anthony Sean Odney-Pacheco, DC
• Jeffrey Shawn Odom
• Kaley Oen
• Sheila Marie Ohman, R.N.

• Family Medicine Physician in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Family Medicine Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.