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

Last updated

Jun 29, 2020By the provider in NPPES

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, and the practitioner matching its NPPES authorized official.

• Amanda Ann Davis, NP

  • Family Medicine Physician
  • Willcox, AZ
  • NPI 1043850795
  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 (Optima Medical)
• Old Pueblo Medical Tranportation, Inc. (Old Pueblo EMS)
• Old Pueblo Pediatrics
• Old Pueblo Plastic Surgery, P.C.
• Old Pueblo Transitional Care Partners LLC (Old Pueblo Specialty Group)
• Old Pueblo Urology,LLC
• Kathleen A Oldfather, NP

• Family Medicine Physician in Tucson, AZ
• Providers in Tucson, AZ by specialty
• 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.