Southern Iowa General Medicine LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

02987 Issued in IA

Legal business name

SOUTHERN IOWA GENERAL MEDICINE LLC

Practice address

105 E McLane St
Suite 400
Osceola, IA 50213-1456

Phone

(641) 342-6337

Fax

(641) 342-6339

NPI assigned

Jun 28, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Carl Roleson, DO

Title

President Ceo

Phone

(515) 237-3974

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193616000000",
    "number": "1043417637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2213 GRAND AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503125305",
            "telephone_number": "515-237-3974",
            "fax_number": "515-883-2692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E MCLANE ST",
            "address_2": "SUITE 400",
            "city": "OSCEOLA",
            "state": "IA",
            "postal_code": "502131456",
            "telephone_number": "641-342-6337",
            "fax_number": "641-342-6339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN IOWA GENERAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-28",
        "last_updated": "2007-10-29",
        "status": "A",
        "authorized_official_last_name": "ROLESON",
        "authorized_official_first_name": "CARL",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "515-237-3974",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "02987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0400207",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.