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1922038249

NPI Code Detail

MEDICARE: RANDALL L. OLIVER, M.D., P.C.

MEDICARE: RANDALL L. OLIVER, M.D., P.C.

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	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000089152	OTHER	IN	ANTHEM FAMILY PRACTICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	719364	OTHER	IN	AFFORDABLE
4	10643	OTHER	IN	HEALTHSOURCE
5	169425	OTHER	IN	HEALTHLINK
6	1006173	OTHER	IN	CHAMPUS
7	659100	OTHER	IN	PRINCIPAL
8	0000000386753	OTHER	IN	ANTHEM PAIN MGMT
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922038249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDALL L. OLIVER, M.D., P.C.

Provider Business Mailing Address
First Line	:	PO BOX 6810
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47719-0810
Country	:	US
Telephone Number	:	812-477-7246
Fax Number	:	812-477-7240

Provider Business Practice Location Address
First Line	:	1101 PROFESSIONAL BLVD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-8016
Country	:	US
Telephone Number	:	812-477-7246
Fax Number	:	812-477-7240

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	RANDALL LEE OLIVER
Credential	:	M.D.
Telephone Number	:	812-477-7246

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	03/19/2013

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Directions to “RANDALL L. OLIVER, M.D., P.C. ” Practice Location

Language	Start Address	Practice Location

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