Active NPI
Jerald Olvido, MT
- Medical Laboratory Technician
- Germantown, TN
National Provider Identifier
1669179164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Laboratory Technician
- License
- 22601
- Practice address
- 7945 Wolf River Blvd
Germantown, TN 38138-1762 - Phone
- (901) 683-0055
- NPI assigned
- Feb 14, 2023
- Last updated
- Feb 14, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Laboratory Technician | 246RM2200X | 22601 | TN | Primary |
Addresses
Primary practice location
7945 Wolf River Blvd
Germantown, TN 38138-1762
Mailing address
9027 Summer Grove CV
Cordova, TN 38018-7498
Phone (901) 832-2191
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22601 | TN | MD | Medical Laboratory Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676332800000",
"number": "1669179164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9027 SUMMER GROVE CV",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380187498",
"telephone_number": "901-832-2191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7945 WOLF RIVER BLVD",
"city": "GERMANTOWN",
"state": "TN",
"postal_code": "381381762",
"telephone_number": "901-683-0055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLVIDO",
"first_name": "JERALD",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-02-14",
"last_updated": "2023-02-14",
"certification_date": "2023-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "246RM2200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Technician, Pathology, Medical Laboratory",
"state": "TN",
"license": "22601",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Germantown, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.