Provider Demographics
NPI:1922038249
Name:RANDALL L. OLIVER, M.D., P.C.
Entity Type:Organization
Organization Name:RANDALL L. OLIVER, M.D., P.C.
Other - Org Name:OLIVER HEADACHE AND PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-477-7246
Mailing Address - Street 1:PO BOX 6810
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47719-0810
Mailing Address - Country:US
Mailing Address - Phone:812-477-7246
Mailing Address - Fax:812-477-7240
Practice Address - Street 1:1101 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8016
Practice Address - Country:US
Practice Address - Phone:812-477-7246
Practice Address - Fax:812-477-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000089152OtherANTHEM FAMILY PRACTICE
KY64872484Medicaid
IN719364OtherAFFORDABLE
IN10643OtherHEALTHSOURCE
IN169425OtherHEALTHLINK
IN1006173OtherCHAMPUS
IN659100OtherPRINCIPAL
IN0000000386753OtherANTHEM PAIN MGMT
IN100180970AMedicaid
IN534830Medicare PIN
IN169425OtherHEALTHLINK
IN1006173OtherCHAMPUS