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INNOVATIVE PSYCHIATRIC CARE PC NPI 1306949896


NPI Information

NPI: 1306949896
Provider Name: INNOVATIVE PSYCHIATRIC CARE PC
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
3900 INGERSOLL AVE
SUITE 108
DES MOINES, IA
ZIP 50312
Phone: (515) 279-6200
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INNOVATIVE PSYCHIATRIC CARE PC is a specialist in Des Moines, IA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. INNOVATIVE PSYCHIATRIC CARE PC NPI is 1306949896. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

3900 INGERSOLL AVE
SUITE 108
DES MOINES, IA
ZIP 50312-534
Phone: (515) 279-6200
Fax: (515) 279-4528

The provider's authorized official is Loren A Olson .
The authorized official title is Owner and has the following contact phone number (515) 279-6200.

The enumeration date for this NPI number is 9/7/2006 and was last updated on 10/30/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TB0200XPsychologistCognitive & BehavioralNo
21041C0700XSocial WorkerClinicalNo
3174400000XSpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1I3968MEDICARE PINIOWA
20249649MEDICAIDIOWA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.