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NPI Code Detail

MEDICARE: RACC MEDICAL ASSOCIATES LLC

MEDICARE: RACC MEDICAL ASSOCIATES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
2207LP2900XPain Medicine (Anesthesiology) Physician
3261QM1200XMagnetic Resonance Imaging (MRI) Clinic/Center
4208100000XPhysical Medicine & Rehabilitation Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184976136
Entity Type Code : Organization
Provider Name (Legal Business Name) : RACC MEDICAL ASSOCIATES LLC
Provider Business Mailing Address
First Line : 1721 MAGNAVOX WAY
Second Line : STE B
City : FORT WAYNE
State : IN
Zip : 46804-1537
Country : US
Telephone Number : 260-748-3650
Fax Number : 260-748-3651
Provider Business Practice Location Address
First Line : 1721 MAGNAVOX WAY
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-1537
Country : US
Telephone Number : 260-748-3650
Fax Number : 260-748-3651
Authorized Official
Title or Position : OWNER
Name : DANIEL C ROTH
Credential : DO
Telephone Number : 260-748-3650
Provider Enumeration Date : 10/15/2012
Last Update Date : 11/05/2024

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1861687923 — DR. DANIEL CHRISTOPHER ROTH DO, MBA, MS
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1548696206 — THOMAS A. STRAUB PA
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Directions to “RACC MEDICAL ASSOCIATES LLC ” Practice Location

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