Old Town Health LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

OLD TOWN HEALTH LLC

Practice address

4700 E Thomas Rd Ste 106
Phoenix, AZ 85018-7702

Phone

(610) 969-5215

NPI assigned

Dec 4, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Deepa Tandon, NP

Title

Manager/Authorized Official

Phone

(610) 969-5215

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615248000000",
    "number": "1184229270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 E THOMAS RD STE 106",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850187702",
            "telephone_number": "610-969-5215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 E THOMAS RD STE 106",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850187702",
            "telephone_number": "610-969-5215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD TOWN HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-04",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A",
        "authorized_official_last_name": "TANDON",
        "authorized_official_first_name": "DEEPA",
        "authorized_official_title_or_position": "MANAGER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "610-969-5215",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Email",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5513 N 76th Pl",
            "city": "Scottsdale",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852506563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jordan R. Oland, M.D.
• Kristen Olander, MSPT
• Immanuel Omogoriola Olarinde, M.D.
• Brad Allen Olberding, MD
• Chad Evan Olberding, LMT
• Shuree Kristine Oldehoeft-Ohlemann, PA-C
• Shaun Edgar Oldridge, LASAC
• Candy Olea Dominguez
• Mackenzie Oleksak
• Paula Marie Olen-Mikrut, M.D.

• Internal Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.