Kodiak Island Medical Associates LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

KODIAK ISLAND MEDICAL ASSOCIATES LLC

Practice address

1818 E Rezanof Dr
Kodiak, AK 99615

Phone

(907) 486-6065

Fax

(907) 486-2248

NPI assigned

Jan 4, 2008

Organization subpart

No

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

Authorized official

Name

Mark E Withrow, MD

Title

Owner MD

Phone

(907) 486-6065

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1199404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199404800000",
    "number": "1609051986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 E REZANOF DR",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "99615",
            "telephone_number": "907-486-6065",
            "fax_number": "907-486-2248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 E REZANOF DR",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "99615",
            "telephone_number": "907-486-6065",
            "fax_number": "907-486-2248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KODIAK ISLAND MEDICAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-04",
        "last_updated": "2008-01-04",
        "status": "A",
        "authorized_official_last_name": "WITHROW",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER MD",
        "authorized_official_telephone_number": "907-486-6065",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kodiak Island Family Dentistry
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• Kodiak Island Health Care Foundation (Kodiak Community Health Center Pharmacy)
• Kodiak Island Medical Associates LLC
• Kodiak Life Diagnostic Imaging, Inc
• Kodiak Vision Clinic & Sally's Eyeland, Inc.
• John M Koller, M.D.
• Alicia Kostelecky

• Multi-Specialty Clinic/Center in Kodiak, AK
• Providers in Kodiak, AK by specialty
• Multi-Specialty Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2008; 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.