Provider Demographics
NPI:1144668583
Name:ODYSSEY SCIENCE INNOVATIONS
Entity type:Organization
Organization Name:ODYSSEY SCIENCE INNOVATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-799-5598
Mailing Address - Street 1:7471 SW SAINT JOHN PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4503
Mailing Address - Country:US
Mailing Address - Phone:503-799-5598
Mailing Address - Fax:
Practice Address - Street 1:7471 SW SAINT JOHN PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-4503
Practice Address - Country:US
Practice Address - Phone:503-799-5598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare