OLDE TOWN MEDICAL


Address: 124 E Pine Ave, Meridian, ID 83642-2331
Phone: 2088875422

OLDE TOWN MEDICAL (NPI# 1245690544) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1245690544
Entity Type Organization
Organization Name OLDE TOWN MEDICAL
Practice Address 124 E Pine Ave
Meridian
ID 83642-2331
Practice Telephone 2088875422
Practice Fax Number 2088886297
Mailing Telephone 2088875422
Mailing Fax Number 2088886297
Enumeration Date 2016-02-29
Last Update Date 2016-03-11
Authorized Official Name SUSAN E TOMEY (PROVIDER/OWNER)
Authorized Official Telephone 2088885422
Authorized Official Credential NP
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LA2200X Nurse Practitioner
Specialization: Adult Health
Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
ID IDAHO NP LICENSE NP-735A 01

Office Location

Street Address 124 E PINE AVE
City MERIDIAN
State ID
Zip Code 83642-2331

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NPI Name Taxonomy Address Enumeration
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1609412683 Meridian Advanced Psychiatry, LLC Psychiatry & Neurology 1672 S Woodsage Ave., Meridan, ID 83642 2019-11-25
1194378927 Sergey Tsema Occupational Therapist 1259 E Pisa St, Meridian, ID 83642 2019-07-21
1003478629 Chris R Jackson Dentist Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 2019-07-03
1285293118 Morgan Family Medicine Nurse Practitioner 1660 S Woodsage Avenue, Meridian, ID 83642 2019-06-13
1033772793 Nugen Healthcare, Pllc Registered Nurse 2177 S Spoonbill Ave, Meridian, ID 83642 2019-04-18
1811471790 Courtney Crossland Physician Assistant 4949 S Hillsdale Ave., Meridian, ID 83642 2018-09-18
1841771938 Katelyn Perry Counselor 2068 S. Eagle Rd., Meridian, ID 83642 2018-08-27
1114406204 Gem Prep: Meridian LLC Case Management 2750 E.gala Ct., Meridian, ID 83642 2018-08-09
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Taxonomy Information

Taxonomy Code 363LA2200X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Adult Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1326513920 Jacquelyn Bruner Ray Nurse Practitioner 6102 11th Ave, Meridian, MS 39305-1219 2018-10-10
1952883571 Ana Linda Laborde Nurse Practitioner 4528 N Bright Angel Ave, Meridian, ID 83646-3655 2018-08-30
1386813632 Mary Ann Howell Nurse Practitioner 2340 N Hills St, Ste F, Meridian, MS 39305-2651 2008-02-20
1356976039 Julianne Hollist Nurse Practitioner 55 W Willowbrook Dr Ste 103, Meridian, ID 83646-3242 2020-03-03
1568911527 Jenna Harper Nurse Practitioner 2124 14th St, Meridian, MS 39301-4040 2016-09-30
1942659735 Lindsey Rigdon Nurse Practitioner 2124 14th St, Meridian, MS 39301-4040 2016-06-13
1609232123 Vickie L Warren Nurse Practitioner 4555 Highland Park Dr, Meridian, MS 39307-5429 2016-01-13
1710227905 Casey Tillery Nurse Practitioner 1600 22nd Ave, Medical Towers IIi, Meridian, MS 39301-3223 2013-02-25
1700076312 Shirley Edna Vanzandt Nurse Practitioner 3025 W Cherry Lane, Ste B, Meridian, ID 83642-8531 2007-07-30
1992787907 Cynthia H. Luther Nurse Practitioner 4331 Highway 39 N, Meridian, MS 39301-1007 2005-11-16
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Competitor

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City MERIDIAN
Zip Code 83642

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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