Healthcare Provider Details

I. General information

NPI: 1467488726
Provider Name (Legal Business Name): STEVEN A ROLLS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 POLE CREEK XING
SIDNEY NE
69162
US

IV. Provider business mailing address

1000 POLE CREEK XING
SIDNEY NE
69162-2901
US

V. Phone/Fax

Practice location:
  • Phone: 308-254-5544
  • Fax:
Mailing address:
  • Phone: 308-254-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number705
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: