ODYSSEY HOUSE INC (NPI# 1407481245) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407481245 |
| Entity Type | Organization |
| Organization Name | ODYSSEY HOUSE INC |
| Practice Address |
743 E 300 S Salt Lake City UT 84102 |
| Mailing Address |
344 E 100 S Ste 301 Salt Lake City UT 84111-1727 |
| Practice Telephone | 8014283500 |
| Practice Fax Number | 8012105031 |
| Mailing Telephone | 8013224257 |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2020-03-11 |
| Authorized Official Name | ADAM COHEN (CEO) |
| Authorized Official Telephone | 8014283449 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Odyssey House Martindale Clinic | Doing Business As Name - Organization |
| Street Address |
743 E 300 S |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84102 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942818604 | Wendy Vazquez | Behavior Technician | 515 S 700 E Suit 2a, Salt Lake City, UT 84102 | 2020-07-20 |
| 1093359960 | Hayle Mayer | Behavior Technician | 515 S 700 E Salt Lake City, Suite 2a, Salt Lake, UT 84102 | 2019-11-04 |
| 1326680869 | Ronald Mcdonald House of The Intermountain Area | Meals | 935 E. South Temple, Salt Lake City, UT 84102 | 2019-10-16 |
| 1508419581 | Claire Pemberton | Behavior Technician | 327 E 1300 S, Apt 2, Salt Lake City, UT 84102 | 2019-07-19 |
| 1558923144 | Olivia Anne Hardwick | Social Worker | Transitions At Slrmc, 86 S. 1100 E. Suite 404, Salt Lake City, UT 84102 | 2019-07-03 |
| 1649741802 | Colten Vancampen | Behavior Technician | 515 S 700 E #2a, Salt Lake City, UT 84102 | 2018-12-16 |
| 1457847964 | Utah Podiatry Group PC | Podiatrist | 24 S 1100 E Ste 120, Salt Lake City, UT 84102 | 2018-07-09 |
| 1104311661 | Malorey Kooyman | Behavior Technician | 515 700 East, Suite 2a, Salt Lake City, UT 84102 | 2018-06-27 |
| 1700384930 | Utah Podiatry Group PC | Podiatrist | 82 S 1100 E Ste 301, Salt Lake City, UT 84102 | 2018-01-23 |
| 1558800045 | Benjamin Cassidy | Specialist/Technologist | 350 S 600 E, #114, Salt Lake City, UT 84102 | 2017-02-16 |
| Find all providers in zip 84102 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| 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. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356957468 | Aubrie Dawn Tilley | Family Medicine | 1741 E Imperial Park Ln, Salt Lake City, UT 84106-3379 | 2020-09-23 |
| 1457969834 | Sandra Lee Porter | Family Medicine | 3979 S Jester Dr, Salt Lake City, UT 84123-1227 | 2020-07-21 |
| 1265057673 | Onsite Care Clinics | Family Medicine | 230 S 500 E Ste 510, Salt Lake City, UT 84102-2028 | 2020-06-11 |
| 1467097071 | Centric Physicians Intermountain Region, Pllc | Family Medicine | 7101 N Mesa Street #365, Salt Lake City, UT 84101-1603 | 2019-11-07 |
| 1760036024 | Mindy Marie Wade | Family Medicine | 1950 E Fort Union Blvd, Salt Lake City, UT 84121-6894 | 2019-07-25 |
| 1841854338 | Tandy Muse | Family Medicine | 4460 S Highland Dr Ste 400, Salt Lake City, UT 84124-3565 | 2019-04-30 |
| 1821561408 | Terra Bowden | Family Medicine | 450 S 900 E Ste 175, Salt Lake City, UT 84102-2981 | 2019-01-07 |
| 1801379193 | Country Corner Family Medicine | Family Medicine | 5460 W Clernates Dr, Salt Lake City, UT 84118-8526 | 2018-09-12 |
| 1396259008 | Futura Medical Clinic | Family Medicine | 1407 W North Temple Ste 120, Salt Lake City, UT 84116-3187 | 2017-11-17 |
| 1255858734 | Fjm Basecamp | Family Medicine | 185 S State St Ste 208, Salt Lake City, UT 84111-1558 | 2017-08-25 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84102 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.