Organization
ODYSSEY ENTERPRISES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES M PENTICUFF JR. (PRACTICE ADMINISTRATOR)
(317) 349-7680
Entity
Organization
Contact information
Practice address
2559 S ADDISYN LN, BLOOMINGTON, IN 47403-3269
(317) 349-7680
(833) 975-0724
Mailing address
2559 S ADDISYN LN, BLOOMINGTON, IN 47403-3269
(317) 349-7680
(833) 975-0724
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/20/2024
Last updated
05/20/2024
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