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JACK R. ROOSSIEN JR. M.D.P.C. NPI 1740406982


NPI Information

NPI: 1740406982
Provider Name: JACK R. ROOSSIEN JR., M.D.P.C.
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
15151 STANTON ST
SUITE A
WEST OLIVE, MI
ZIP 49460
Phone: (616) 296-1020
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JACK R. ROOSSIEN JR., M.D.P.C. is a family medicine in West Olive, MI. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. JACK R. ROOSSIEN JR., M.D.P.C. NPI is 1740406982. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

15151 STANTON ST
SUITE A
WEST OLIVE, MI
ZIP 49460-543
Phone: (616) 296-1020
Fax: (616) 296-1030

The provider's authorized official is Jack Richard Roossien .
The authorized official title is President and has the following contact phone number (616) 296-1020.

The enumeration date for this NPI number is 4/17/2007 and was last updated on 5/27/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine4301050437MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1E34750MEDICARE UPINMICHIGAN
24214810MEDICAIDMICHIGAN
3ON13120OTHERMICHIGANMEDICARE GROUP NUMBER
4N13120001MEDICARE PINMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.