Smith, Roosevelt
Smith, Roosevelt is an individual health care provider with primary practice located at 62 E 3Rd St Suite 3, Winona MN 55987-3481. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Smith, Roosevelt can be contacted via phone (507) 474-4770.Contact Information
Primary practice address
62 E 3Rd St Suite 3
Winona MN 55987-3481
Phone: (507) 474-4770
Fax: (507) 474-4774
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 9155 | Minnesota |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 500023 | Wisconsin |
Profile Details
| NPI number | 1003836701 |
|---|---|
| LBN Legal business name | Smith, Roosevelt |
| Credentials | PAC, ATR |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 19th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1003836701 | NPPES |
| Minnesota | Other | 0121686 | MEDICA |
| Minnesota | Other | 679G2SM | MEDICA |
| Minnesota | Other | HP32318 | MEDICA |
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