Rolla Children'S Clinic, P.C.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

ROLLA CHILDREN'S CLINIC, P.C.

Practice address

1050 W 10TH St
Suite 480
Rolla, MO 65401-2905

Phone

(573) 364-1900

Fax

(573) 364-7365

NPI assigned

Feb 15, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Robert Bruce Russell

Title

Manager

Phone

(573) 364-1900

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1203033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203033600000",
    "number": "1780852384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST",
            "address_2": "SUITE 480",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-364-1900",
            "fax_number": "573-364-7365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST",
            "address_2": "SUITE 480",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-364-1900",
            "fax_number": "573-364-7365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROLLA CHILDREN'S CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-15",
        "last_updated": "2008-02-15",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "573-364-1900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Ritz, LPC
• Casey J Robertson, ATC, LAT
• Mary Kathleen Robinson-Black, L.P.C.
• Shannon Liane Robinson, M.D.
• Cathleen E Rodriguez, LPC
• Rolla Dermatology LLC
• Rolla Family Dentistry Inc
• Rolla Grand LLC
• Rolla Health Care LLC
• Rolla Manor, Inc.

• Pediatrics Physician in Rolla, MO
• Providers in Rolla, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.