Provider Demographics
NPI:1871143230
Name:ODEN, BARRY
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:ODEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BROWN A VE
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064
Mailing Address - Country:US
Mailing Address - Phone:913-602-1741
Mailing Address - Fax:
Practice Address - Street 1:305 BROWN A VE
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064
Practice Address - Country:US
Practice Address - Phone:913-602-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider