MEDICARE: ROSKAMP FOUNDATION IRRV TR

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
1	174400000X	Specialist

General Provider Information

NPI Number	:	1952512501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSKAMP FOUNDATION IRRV TR

Provider Business Mailing Address
First Line	:	2040 WHITFIELD AVE
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34243-3922
Country	:	US
Telephone Number	:	941-752-2949
Fax Number	:

Provider Business Practice Location Address
First Line	:	10770 N 46TH ST
Second Line	:	STE C-900
City	:	TAMPA
State	:	FL
Zip	:	33617-3442
Country	:	US
Telephone Number	:	813-979-2008
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE COORDINATOR
Name	:	PETER PARSONSON
Credential	:
Telephone Number	:	941-752-2949

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	08/22/2020

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Directions to “ROSKAMP FOUNDATION IRRV TR ” Practice Location

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