ROOSEVELT SMITH JR. (NPI# 1003836701) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003836701 |
| Entity Type | Individual |
| Full Name | ROOSEVELT SMITH JR. |
| Credential | PAC, ATR |
| Practice Address |
62 E 3rd St Suite 3 Winona MN 55987-3481 |
| Practice Telephone | 5074744770 |
| Practice Fax Number | 5074744774 |
| Mailing Telephone | 5074744770 |
| Mailing Fax Number | 5074744774 |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
500023 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
9155 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BCBS MN | 679G2SM | 01 |
| MN | HEALTH PARTNERS | HP32318 | 01 |
| MN | MEDICA | 0121686 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235235680 | Roosevelt J Smith | Chiropractor | 4518-a West Market St, Greensboro, NC 27407 | 2006-09-15 |
| 1386178614 | Roosevelt Smith | Counselor | 5455 Almira Dr Ne, Bremerton, WA 98311-8330 | 2017-04-13 |
| Street Address |
62 E 3RD ST SUITE 3 |
| City | WINONA |
| State | MN |
| Zip Code | 55987-3481 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326064908 | Nsu Inc | Physician Assistant | 62 E 3rd St, Suite 3, Winona, MN 55987-3481 | 2006-07-15 |
| 1477573004 | Steven R Vogel | Family Medicine | 62 E 3rd St, Suite 3, Winona, MN 55987-3481 | 2006-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891277232 | Jamie Sanders | Social Worker | 51 East 4th St Suite 307, Winona, MN 55987 | 2018-09-01 |
| 1841727823 | Stacey A Czaplewski | Specialist/Technologist | 175 West Mark Street, Winona State University-139 Memorial Hall, Winona, MN 55987 | 2017-05-22 |
| 1083145361 | Kevin Lee Knack | Counselor | 902 E. Second St. Suite 326, Acumen Counseling, Winona, MN 55987 | 2017-03-27 |
| 1467993865 | Melissa Lee Peterson | Specialist/Technologist | 23559 Co. Rd. 20, Winona, MN 55987 | 2017-03-17 |
| 1790226280 | Nikolas Porter Lyon | Specialist/Technologist | 634 Franklin St, East Lake B 306-4, Winona, MN 55987 | 2017-03-16 |
| 1821424953 | Sara Beth Borchardt | Chiropractor | 1423 West Service Drive, Winona, MN 55987 | 2013-09-20 |
| 1952614273 | Kristin Janelle Noble | Chiropractor | 117 W. 3rd St., Winona, MN 55987 | 2010-07-15 |
| 1033435615 | Christine E. Clark | Pharmacist | 1122 Hwy 61, Winona, MN 55987 | 2010-04-08 |
| 1346401544 | Andrew Dean Mork | Dentist | 50 W Second Street, Winona, MN 55987 | 2008-06-19 |
| 1508073693 | Lawrence J Green | Psychologist | 61 W 4th St, Winona, MN 55987 | 2007-05-17 |
| Find all providers in zip 55987 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811974801 | Cindy Lynn Gile | Physician Assistant | 1122 W Highway 61, Winona, MN 55987-1957 | 2005-12-29 |
| 1184275794 | Kelli Ann Polum | Physician Assistant | 1122 W Highway 61, Winona, MN 55987-1957 | 2019-09-25 |
| 1396110516 | Kara Kristine Reller | Physician Assistant | 420 E Sarnia St, Winona, MN 55987-6365 | 2015-12-14 |
| 1841671500 | Stephanie Frisch Lewis | Physician Assistant | 855 Mankato Ave, Winona, MN 55987-4868 | 2015-06-17 |
| 1720374663 | Denver Todd Brown | Physician Assistant | 855 Mankato Ave, Winona, MN 55987-4868 | 2011-06-20 |
| 1154439487 | Neil H Tator | Physician Assistant | 1122 W Highway 61, Winona, MN 55987-1957 | 2006-08-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255969150 | Isaac Waalen | Physician Assistant | 5420 Circle Down, Minneapolis, MN 55416-1312 | 2020-03-28 |
| 1730643701 | Christina Jones | Physician Assistant | 11850 Blackfoot St Nw Ste 270, Coon Rapids, MN 55433-2593 | 2019-01-24 |
| 1114492964 | Molly Goss | Physician Assistant | 1817 Sunset Dr, Northfield, MN 55057-3246 | 2018-10-09 |
| 1932600160 | Ellen Kathryn Freeman | Physician Assistant | 111 Hundertmark Rd Ste 480, Chaska, MN 55318-1485 | 2018-02-22 |
| 1174041875 | Kristen Webb | Physician Assistant | 3931 Louisiana Ave S, Suite E-500, St. Louis Park, MN 55426 | 2017-09-01 |
| 1073051751 | Hannah Elizabeth Rosenthal Danielson | Physician Assistant | 640 Jackson St # Ms 11102m, Saint Paul, MN 55101 | 2017-02-02 |
| 1457893984 | Daniel Ryan Nguyen | Physician Assistant | 14551 Co Rd #11 #100, Burnsville, MN 55337 | 2016-11-15 |
| 1538545686 | Kathryn Jelle | Physician Assistant | 3931 Louisiana Ave S # 55426, St Louis Park, MN 55426-5000 | 2015-07-30 |
| 1831503267 | Karrah Oliver | Physician Assistant | 205 Roosevelt Ave W, Karlstad, MN 56732-4022 | 2014-06-13 |
| 1477981777 | Melissa Ferraz De Toledo | Physician Assistant | 9145 Springbrook Dr Nw Ste 300, Coon Rapids, MN 55433-5897 | 2013-10-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.