MEDICARE: RANDY L WIRTZ ARNP

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	363LF0000X	Family Nurse Practitioner	A056327	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00195265	OTHER	IA	RAILROAD 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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	38469	OTHER	IA	WELLMARK BC/BS IOWA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982681094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY L WIRTZ ARNP

Provider Business Mailing Address
First Line	:	160 E MAIN ST
Second Line	:
City	:	DENVER
State	:	IA
Zip	:	50622-9612
Country	:	US
Telephone Number	:	319-984-5645
Fax Number	:	319-984-5364

Provider Business Practice Location Address
First Line	:	160 E MAIN ST
Second Line	:
City	:	DENVER
State	:	IA
Zip	:	50622-9612
Country	:	US
Telephone Number	:	319-984-5645
Fax Number	:	319-984-5364

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	10/22/2007

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