Olde Town Medical

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

OLDE TOWN MEDICAL

Practice address

124 E Pine Ave
Meridian, ID 83642-2331

Phone

(208) 887-5422

Fax

(208) 888-6297

NPI assigned

Feb 29, 2016

Organization subpart

No

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

Authorized official

Name

Susan E Tomey, NP

Title

Provider/Owner

Phone

(208) 888-5422

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1456704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457654400000",
    "number": "1245690544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 E PINE AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422331",
            "telephone_number": "208-887-5422",
            "fax_number": "208-888-6297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 E PINE AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422331",
            "telephone_number": "208-887-5422",
            "fax_number": "208-888-6297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLDE TOWN MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-29",
        "last_updated": "2016-03-11",
        "status": "A",
        "authorized_official_last_name": "TOMEY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "208-888-5422",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO NP LICENSE",
            "identifier": "NP-735A",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberley Helen Odom, FNP
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• Barry Lee Oglesbee, DC
• Catherine Danielle Olaso
• Elizabeth Oler, PHARM.D.
• Brianne Fay Oliphant, SLP
• Rachael Meyer Olmstead, LCSW
• Babatunde Samuel Olowu, PMHNP-BC
• Amy Olsen, LCPC

• Adult Health Nurse Practitioner in Meridian, ID
• Providers in Meridian, ID by specialty
• Adult Health Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2016; 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.