1538416052 NPI number — JAMES W. ROAT, M.D., P.C.

Table of content: (NPI 1538416052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538416052 NPI number — JAMES W. ROAT, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES W. ROAT, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538416052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2910 HAMILTON BLVD STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51104-2423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-252-1322
Provider Business Mailing Address Fax Number:
712-252-1353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2910 HAMILTON BLVD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51104-2423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-252-1322
Provider Business Practice Location Address Fax Number:
712-252-1353
Provider Enumeration Date:
08/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ROAT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
712-252-1322

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  23838 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100028460A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 75985 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 239763300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: A002980 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 205156003 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20520 . This is a "NEBRASKA BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: XPY047960 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073972 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100000543 . This is a "TRAVELERS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 208371 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2984768 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7775360 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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