Provider Demographics
NPI:1750322103
Name:ODDEN, TONIA (PA-C)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:
Last Name:ODDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-0430
Mailing Address - Country:US
Mailing Address - Phone:515-832-9400
Mailing Address - Fax:515-832-9420
Practice Address - Street 1:731 MAIN ST
Practice Address - Street 2:
Practice Address - City:JEWELL
Practice Address - State:IA
Practice Address - Zip Code:50130-2040
Practice Address - Country:US
Practice Address - Phone:515-827-6175
Practice Address - Fax:515-827-6189
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03253OtherMEDICARE HOSPITAL PART B
IA0283465Medicaid
IA0600460Medicaid
IA0655001Medicaid
IA36174OtherBCBS DME
IA0424507Medicaid
IA29352OtherBCBS ER
IA33444OtherFPC BCBS NRH
IA66046OtherBCBS SNF
IA0635011Medicaid
IA0293522Medicaid
IA60046OtherBCBS REG
IADA1838Medicare ID - Type UnspecifiedFPC MEDICARE RR
IA0655001Medicaid
IA0635011Medicaid
IACE8231Medicare Oscar/Certification
IA29352OtherBCBS ER
IA0424507Medicaid
IA66046OtherBCBS SNF
IA0293522Medicaid