MEDICARE: DR. CHRIS ROBERT JENSEN 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	207Q00000X	Family Medicine Physician	01052736A	IN
2	207Q00000X	Family Medicine Physician	MD-37321	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00624147	OTHER	IA	RR MEDICARE

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	:	1942298088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRIS ROBERT JENSEN M.D.

Provider Business Mailing Address
First Line	:	301 E HILLCREST AVE
Second Line	:
City	:	INDIANOLA
State	:	IA
Zip	:	50125-9027
Country	:	US
Telephone Number	:	515-961-3700
Fax Number	:	515-962-0160

Provider Business Practice Location Address
First Line	:	301 E HILLCREST AVE
Second Line	:
City	:	INDIANOLA
State	:	IA
Zip	:	50125-9027
Country	:	US
Telephone Number	:	515-961-3700
Fax Number	:	515-962-0160

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	03/11/2015

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