NPIMap

Organization Active NPI

Celldox Inc

  • Anatomic Pathology & Clinical Pathology Physician
  • Hannibal, MO
National Provider Identifier
1962515239
Registry record updated May 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
00166253 Issued in MO
Legal business name
CELLDOX INC
Practice address
6470 Interstate CT
Hannibal, MO 63401-6759
Phone
(573) 248-0826
Fax
(573) 221-2252
NPI assigned
Aug 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2010

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

Authorized official

Name
Dr. Thomas A Roisum, MD
Title
President
Phone
(573) 248-0226

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X 00166253 MO Primary

Addresses

Primary practice location

6470 Interstate CT
Hannibal, MO 63401-6759

Mailing address

6470 Interstate CT
Hannibal, MO 63401-6759
Phone (573) 248-0226

Other identifiers 1

IdentifierTypeStateIssuer
501875306MedicaidMO

National Provider Directory

National Provider Directory

Locations

6470 Interstate Ct
Hannibal, MO 63401
Phone (573) 248-0826

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273795200000",
    "number": "1962515239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6470 INTERSTATE CT",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016759",
            "telephone_number": "573-248-0226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6470 INTERSTATE CT",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016759",
            "telephone_number": "573-248-0826",
            "fax_number": "573-221-2252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CELLDOX INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2010-05-14",
        "status": "A",
        "authorized_official_last_name": "ROISUM",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-248-0226",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MO",
            "license": "00166253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "501875306",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hannibal, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2010; 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.