Provider Demographics
NPI:1023224904
Name:ODESSA MEDICAL CLINIC, PC
Entity type:Organization
Organization Name:ODESSA MEDICAL CLINIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZINK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-230-8777
Mailing Address - Street 1:408 N. 4TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ODESSA
Mailing Address - State:MO
Mailing Address - Zip Code:64076-1646
Mailing Address - Country:US
Mailing Address - Phone:816-230-8777
Mailing Address - Fax:816-230-8855
Practice Address - Street 1:408 N. 4TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:ODESSA
Practice Address - State:MO
Practice Address - Zip Code:64076-1646
Practice Address - Country:US
Practice Address - Phone:816-230-8777
Practice Address - Fax:816-230-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODOR9F95207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12844049OtherBCBSKC INDIVIDUAL PROV
MO31334013OtherBCBSKC GRP NUMBER
MOM140000OtherMEDICARE GROUP NUMBER
MOM140000OtherMEDICARE GROUP NUMBER
MOP10459Medicare UPIN
MOP00320895Medicare ID - Type UnspecifiedRRMC PIN-ADAMS
MOM14B483Medicare ID - Type UnspecifiedMC INDIVIDUAL PROV# ADAMS
MOCJ9934Medicare ID - Type UnspecifiedRR MEDICARE GROUP
MOM145922Medicare ID - Type UnspecifiedINDIVIDUAL PROV # ZINK
MO=========OtherTIN
MO31334013OtherBCBSKC GRP NUMBER
MOE82026Medicare UPIN
MO080185566Medicare ID - Type UnspecifiedRR MC INDIV PROV # ZINK