ODAM MEDICAL GROUP (NPI# 1902392525) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902392525 |
| Entity Type | Organization |
| Organization Name | ODAM MEDICAL GROUP |
| Other Organization Name | ODAM MEDICAL GROUP - ST. CLOUD |
| Practice Address |
3405 3rd St N Saint Cloud MN 56303-4015 |
| Mailing Address |
920 E 28th St # Ll40 Minneapolis MN 55407-1139 |
| Practice Telephone | 6128712312 |
| Practice Fax Number | 6128712163 |
| Mailing Telephone | 6128712312 |
| Mailing Fax Number | 6128712163 |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2018-07-06 |
| Authorized Official Name | DR. ROBERT LARBI-ODAM (CEO) |
| Authorized Official Telephone | 6128712312 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| ODAM MEDICAL GROUP - ST. CLOUD | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578934683 | Odam Medical Group | Clinic/Center | 920 E 28th St # Ll40, Minneapolis, MN 55407-1139 | 2015-10-14 |
| Street Address |
3405 3RD ST N |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56303-4015 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275197014 | Nasro Abdulkadir Ahmed | Nurse Practitioner | 3405 3rd St N, Saint Cloud, MN 56303-4015 | 2019-04-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922309582 | Best of Health Medical Clinic,llc | Clinic/Center | 524 13 Th Street, Saint Cloud, FL 34769 | 2010-11-12 |
| 1518268283 | Walk In Medical Clinic and Fitness Center, LLC | Clinic/Center | 3105 Innovation Dr Ste A, Saint Cloud, FL 34769-6501 | 2010-11-10 |
| 1114414380 | Jose A Rivera | Clinic/Center | 3201 Budinger Ave, Saint Cloud, FL 34769-7203 | 2018-04-13 |
| 1730692450 | Carrousel Health Care Corporation | Clinic/Center | 3201 Budinger Ave, Saint Cloud, FL 34769-7203 | 2017-11-16 |
| 1689196339 | Centracare Clinic | Clinic/Center | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2017-07-14 |
| 1538696323 | Centracare Clinic | Clinic/Center | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2017-05-11 |
| 1336520105 | Cloud Care LLC | Clinic/Center | 3720 Cord Ave, Saint Cloud, FL 34772-8061 | 2015-06-17 |
| 1881004596 | Z Medical Center LLC | Clinic/Center | 1600 Budinger Ave Ste A, Saint Cloud, FL 34769-6007 | 2014-05-02 |
| 1790124741 | East Lake Medical Clinic | Clinic/Center | 4737 Old Canoe Creek Rd, Saint Cloud, FL 34769-1400 | 2013-06-21 |
| 1457405763 | Centracare Clinic | Clinic/Center | 1900 Centracare Cir, Suite 1450, Saint Cloud, MN 56303-5000 | 2007-01-23 |
| Find all providers in SAINT CLOUD | ||||
| City | SAINT CLOUD |
| Zip Code | 56303 |
Please comment or provide details below to improve the information on ODAM MEDICAL GROUP.
| 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.