Healthcare Provider Details

I. General information

NPI: 1447215066
Provider Name (Legal Business Name): JAMES C ROELKE P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 HOSPITAL DR GROUND FLOOR, SUITE A
MOUNTAIN HOME AR
72653-2953
US

IV. Provider business mailing address

628 HOSPITAL DR GROUND FLOOR, SUITE A
MOUNTAIN HOME AR
72653-2953
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-4402
  • Fax: 870-424-3089
Mailing address:
  • Phone: 870-425-4402
  • Fax: 870-424-3089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: