Basic Information
Provider Information | |||||||||
NPI: | 1376769026 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | OLMSTED | ||||||||
FirstName: | THOMAS | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 9161 CEDAR RDG | ||||||||
Address2: |   | ||||||||
City: | LANTANA | ||||||||
State: | TX | ||||||||
PostalCode: | 762264344 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9407250047 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3535 S INTERSTATE 35 E | ||||||||
Address2: |   | ||||||||
City: | DENTON | ||||||||
State: | TX | ||||||||
PostalCode: | 762106850 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9403843535 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/18/2007 | ||||||||
LastUpdateDate: | 07/01/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | DO 2036 | TN | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | 20629 | MS | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | E-8234 | AR | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | P-7827 | TX | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | P01277786 | 01 | TX | RAILROAD MEDICARE | OTHER | 331188801 | 05 | TX |   | MEDICAID |