MEDICARE: JOSE A. OLIVENCIA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	19393	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20015691	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	6702	OTHER	MIDLANDS CHOICE
3	02396	OTHER	WELLMARK
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1700237	OTHER	UNITED HEALTHCARE
7	663357	OTHER	FIRST HEALTH

General Provider Information

NPI Number	:	1821101478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE A. OLIVENCIA M.D.

Provider Business Mailing Address
First Line	:	2425 WESTOWN PKWY
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1425
Country	:	US
Telephone Number	:	515-222-8346
Fax Number	:	515-222-0472

Provider Business Practice Location Address
First Line	:	2425 WESTOWN PKWY
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1425
Country	:	US
Telephone Number	:	515-222-8346
Fax Number	:	515-222-0472

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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Directions to “ JOSE A. OLIVENCIA M.D.” Practice Location

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