MEDICARE: INNOVATIVE PSYCHIATRIC CARE PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TB0200X	Cognitive & Behavioral Psychologist
2	1041C0700X	Clinical Social Worker
3	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306949896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE PSYCHIATRIC CARE PC

Provider Business Mailing Address
First Line	:	3900 INGERSOLL AVE
Second Line	:	SUITE 108
City	:	DES MOINES
State	:	IA
Zip	:	50312-3534
Country	:	US
Telephone Number	:	515-279-6200
Fax Number	:	515-279-4528

Provider Business Practice Location Address
First Line	:	3900 INGERSOLL AVE
Second Line	:	SUITE 108
City	:	DES MOINES
State	:	IA
Zip	:	50312-3534
Country	:	US
Telephone Number	:	515-279-6200
Fax Number	:	515-279-4528

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LOREN A OLSON
Credential	:	M.D.
Telephone Number	:	515-279-6200

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	10/30/2007

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Directions to “INNOVATIVE PSYCHIATRIC CARE PC ” Practice Location

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