| Odyssey House Inc | |
|
340 E 100 S Salt Lake City UT 84111-1702 | |
| (801) 322-3222 | |
| (801) 322-2831 |
| Full Name | Odyssey House Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 340 E 100 S, Salt Lake City, Utah |
| Authorized Official Name and Position | Adam Cohen (CEO) |
| Authorized Official Contact | 8014283449 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Odyssey House Inc 344 E 100 S Ste 301 Salt Lake City UT 84111-1727 Ph: (801) 322-4257 | Odyssey House Inc 340 E 100 S Salt Lake City UT 84111-1702 Ph: (801) 322-3222 |
| NPI Number | 1033143706 |
|---|---|
| Provider Enumeration Date | 07/10/2006 |
| Last Update Date | 11/30/2023 |
| Certification Date | 11/30/2023 |
| Medicare PECOS PAC ID | 2365458833 |
|---|---|
| Medicare Enrollment ID | O20060222000116 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033143706 | NPI | - | NPPES |
| Provider Name | Dean Arthur Mayer |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1316915432 PECOS PAC ID: 4284682592 Enrollment ID: I20050104000213 |
| Provider Name | Jamal Hejazi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558332437 PECOS PAC ID: 2567496938 Enrollment ID: I20050924000262 |
| Provider Name | Richard C Arbogast |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376613141 PECOS PAC ID: 4789576984 Enrollment ID: I20080312000232 |
| Provider Name | Paula Jane Cook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922209386 PECOS PAC ID: 7618015157 Enrollment ID: I20091103000706 |
| Provider Name | Christina D Zidow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629396270 PECOS PAC ID: 3870718554 Enrollment ID: I20140813001199 |
| Provider Name | Kamile M Weischedel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225327927 PECOS PAC ID: 8426275710 Enrollment ID: I20150529000924 |
| Provider Name | Gon Thi Lam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891179339 PECOS PAC ID: 6002126844 Enrollment ID: I20151109000117 |
| Provider Name | Jessica L Arbogast |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154721108 PECOS PAC ID: 7416264544 Enrollment ID: I20160104001127 |
| Provider Name | Siosi Fonua |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750789624 PECOS PAC ID: 2163794173 Enrollment ID: I20170824002581 |
| Provider Name | Armando Wayne Slack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659572949 PECOS PAC ID: 7315288024 Enrollment ID: I20190408000135 |
| Provider Name | Stephanie Wheatley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922573633 PECOS PAC ID: 6709119365 Enrollment ID: I20190613001011 |
| Provider Name | Shane Maylin Pitcher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487973863 PECOS PAC ID: 8820416852 Enrollment ID: I20200908002287 |
| Provider Name | Melissa Radcliffe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992356240 PECOS PAC ID: 6103244306 Enrollment ID: I20200921002538 |
| Provider Name | Bozena Montes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558778902 PECOS PAC ID: 5395963987 Enrollment ID: I20210106000215 |
| Provider Name | Yuri Kubotera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295323665 PECOS PAC ID: 8224431077 Enrollment ID: I20210730001986 |
| Provider Name | Windi Kay Woods |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265103790 PECOS PAC ID: 2769871532 Enrollment ID: I20211116003303 |
| Provider Name | Alexandra Leigh Gebhardt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023746641 PECOS PAC ID: 1850767146 Enrollment ID: I20221011001553 |
| Provider Name | Kristina Muck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225565930 PECOS PAC ID: 2264898147 Enrollment ID: I20230518002501 |
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