Odland Family Practice Clinic, Llc | |
950 E Bogard Rd Suite 234 Wasilla AK 99654-7184 | |
(907) 355-0850 | |
(907) 373-0117 |
Full Name | Odland Family Practice Clinic, Llc |
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Speciality | Family Medicine |
Location | 950 E Bogard Rd, Wasilla, Alaska |
Authorized Official Name and Position | Shannon Pendergrass (BILLING MANAGER) |
Authorized Official Contact | 9073550850 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Odland Family Practice Clinic, Llc 950 E Bogard Rd Suite 234 Wasilla AK 99687-9481 Ph: (907) 355-0850 | Odland Family Practice Clinic, Llc 950 E Bogard Rd Suite 234 Wasilla AK 99654-7184 Ph: (907) 355-0850 |
NPI Number | 1114269313 |
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Provider Enumeration Date | 03/26/2013 |
Last Update Date | 03/26/2013 |
Medicare PECOS PAC ID | 8022255835 |
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Medicare Enrollment ID | O20130515000681 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114269313 | NPI | - | NPPES |
MD1574 | Medicaid | AK | |
MD9857 | Medicaid | AK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 955730 (Alaska) | Primary |
Provider Name | Susan K Sparling |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1679532501 PECOS PAC ID: 8729185707 Enrollment ID: I20210526002796 |
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