Provider Demographics
NPI:1457016560
Name:ROOTS PSYCHIATRIC SERVICES PC
Entity Type:Organization
Organization Name:ROOTS PSYCHIATRIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:DRUMMOND
Authorized Official - Last Name:ROOTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-250-9737
Mailing Address - Street 1:2801 MARSHALL CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2257
Mailing Address - Country:US
Mailing Address - Phone:800-516-0975
Mailing Address - Fax:
Practice Address - Street 1:2801 MARSHALL CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2257
Practice Address - Country:US
Practice Address - Phone:800-516-0975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEND HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty