Provider Demographics
NPI:1235404625
Name:C. MICHEL OLIVA, M.D. PA
Entity Type:Organization
Organization Name:C. MICHEL OLIVA, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:C. MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:806-791-3377
Mailing Address - Street 1:PO BOX 64123
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79464-4123
Mailing Address - Country:US
Mailing Address - Phone:806-791-3377
Mailing Address - Fax:806-791-3378
Practice Address - Street 1:4404 6TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4732
Practice Address - Country:US
Practice Address - Phone:806-791-3377
Practice Address - Fax:806-791-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8299208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF65407Medicare PIN