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).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
ID | IDAHO NP LICENSE | NP-735A | 01 |
Street Address |
124 E PINE AVE |
City | MERIDIAN |
State | ID |
Zip Code | 83642-2331 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
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 |
Find all providers in zip 83642 |
Taxonomy Code | 363LA2200X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Adult Health |
Definition to come... |
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 |
Find all providers in MERIDIAN |
Please comment or provide details below to improve the information on OLDE TOWN MEDICAL.
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.