Si Roaten, R.T. (R)(CT)

Key facts

NPI

1003312877

Entity type

Individual (NPI type 1)

Primary specialty

Computed Tomography Radiologic Technologist 2471C3401X

License

12633 (LA)

Practice address

115 Gayven Dr
Ball, LA 71405-4901

Phone

(731) 267-6911

NPI assigned

Apr 2, 2018

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 2, 2018.

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522627200000",
    "number": "1003312877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 SHERWOOD DR",
            "city": "DRY PRONG",
            "state": "LA",
            "postal_code": "714238755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 GAYVEN DR",
            "city": "BALL",
            "state": "LA",
            "postal_code": "714054901",
            "telephone_number": "731-267-6911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROATEN",
        "first_name": "SI",
        "credential": "R.T. (R)(CT)",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-02",
        "last_updated": "2018-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2471C3401X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Computed Tomography",
            "state": "LA",
            "license": "12633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Ball, LA · Computed Tomography Radiologic Technologist in Louisiana