Old Pueblo Mobile Medicine LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

OLD PUEBLO MOBILE MEDICINE LLC

Practice address

9721 E Colette St
Tucson, AZ 85748-2756

Phone

(520) 314-1008

Fax

(682) 201-2429

NPI assigned

Jun 29, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Amanda A Davis, NPNPI 1043850795

Title

Nurse Practitioner

Phone

(520) 822-4423

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amanda Ann Davis, NP

  • Family Medicine Physician
  • Willcox, AZ
  • NPI 1043850795

  Family Medicine

  NPD (past) Authorized official

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

{
    "created_epoch": "1593388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593388800000",
    "number": "1609493402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9721 E COLETTE ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857482756",
            "telephone_number": "520-314-1008",
            "fax_number": "682-201-2429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9721 E COLETTE ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857482756",
            "telephone_number": "520-314-1008",
            "fax_number": "682-201-2429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD PUEBLO MOBILE MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-29",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "520-822-4423",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Old Pueblo Community Services
• Old Pueblo Counseling, Incorporated
• Old Pueblo Dermatology LTD
• Old Pueblo Healthcare LLC
• Old Pueblo Medical Tranportation, Inc.
• Old Pueblo Pediatrics
• Old Pueblo Plastic Surgery, P.C.
• Old Pueblo Transitional Care Partners LLC
• Old Pueblo Urology,LLC
• Kathleen A Oldfather, NP

• All providers in Tucson, AZ
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2020; 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.