Provider Demographics
NPI:1538416052
Name:JAMES W. ROAT, M.D., P.C.
Entity type:Organization
Organization Name:JAMES W. ROAT, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ROAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-252-1322
Mailing Address - Street 1:2910 HAMILTON BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2423
Mailing Address - Country:US
Mailing Address - Phone:712-252-1322
Mailing Address - Fax:712-252-1353
Practice Address - Street 1:2910 HAMILTON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-2423
Practice Address - Country:US
Practice Address - Phone:712-252-1322
Practice Address - Fax:712-252-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23838207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100028460AMedicaid
MT75985Medicaid
MN239763300Medicaid
A002980OtherTRICARE
MO205156003Medicaid
NE20520OtherNEBRASKA BLUE SHIELD
CAXPY047960Medicaid
WA1073972Medicaid
100000543OtherTRAVELERS MEDICARE
IA208371Medicaid
CO2984768Medicaid
SD7775360Medicaid
IA208371Medicaid
MO205156003Medicaid