=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447501473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPALACHIAN PSYCHIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2012
-----------------------------------------------------
Last Update Date | 10/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 COURT ST SE
-----------------------------------------------------
City | ABINGDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24210-3300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-628-4926
-----------------------------------------------------
Fax | 276-628-4936
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 COURT ST SE
-----------------------------------------------------
City | ABINGDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24210-3300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-628-4926
-----------------------------------------------------
Fax | 276-628-4936
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | THOMAS RUSSELL OLMSTED
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 276-628-4926
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 0101237200
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------