MEDICARE: JERIMIE JAMEE JACOB OLVERA

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	332BX2000X	Oxygen Equipment & Supplies (DME)		CO

General Provider Information

NPI Number	:	1598268294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERIMIE JAMEE JACOB OLVERA

Provider Business Mailing Address
First Line	:	PO BOX 33611
Second Line	:
City	:	NORTHGLENN
State	:	CO
Zip	:	80233-0611
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11674 GRANBY ST
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80603-7203
Country	:	US
Telephone Number	:	720-255-6889
Fax Number	:

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

Provider Enumeration Date	:	03/09/2018
Last Update Date	:	03/09/2018

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