Provider Demographics
NPI:1649394842
Name:IOWA VEIN CENTER, INC.
Entity Type:Organization
Organization Name:IOWA VEIN CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLIVENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-222-8346
Mailing Address - Street 1:2425 WESTOWN PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1425
Mailing Address - Country:US
Mailing Address - Phone:515-222-8346
Mailing Address - Fax:515-222-0472
Practice Address - Street 1:2425 WESTOWN PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1425
Practice Address - Country:US
Practice Address - Phone:515-222-8346
Practice Address - Fax:515-222-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IACS6841OtherRAILROAD MEDICARE
IA22927OtherWELLMARK
IA22927OtherWELLMARK