Rose Stahlecker, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PAC0100 Issued in ND

Practice address

420 South 7TH Street
Oakes, ND 58474-2024

Phone

(701) 742-3267

Fax

(701) 742-3201

NPI assigned

Oct 19, 2005

Last updated

May 21, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southeast Medical Center PC

  • Community Health Clinic/Center
  • Lisbon, ND
  • NPI 1124034509
  NPD (past)

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211328000000",
    "number": "1144219429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50",
            "city": "OAKES",
            "state": "ND",
            "postal_code": "584740050",
            "telephone_number": "701-742-3267",
            "fax_number": "701-742-3201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 SOUTH 7TH STREET",
            "city": "OAKES",
            "state": "ND",
            "postal_code": "584742024",
            "telephone_number": "701-742-3267",
            "fax_number": "701-742-3201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAHLECKER",
        "first_name": "ROSE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-19",
        "last_updated": "2008-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ND",
            "license": "PAC0100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "28586",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "18134",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "25977",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAVELERS MEDICARE",
            "identifier": "970009835",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "18133",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "28585",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "19187",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "19188",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Brennan Scott
• Kathleen Lee Siedschlag, PA-C
• Southeast Therapy Services Inc
• Sozo Physical Therapy PC
• Michael Spiese, R.PH.
• Taras Thrifty White
• The Evangelical Lutheran Good Samaritan Society (Oakes Manor Good Samaritan Center)
• Toby Thielges, PTMS
• Tru Aesthetic and Wellness, PLLC
• Deanne Visto, RPH

• Medical Physician Assistant in Oakes, ND
• Providers in Oakes, ND by specialty
• Medical Physician Assistant in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; 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.