Provider Demographics
NPI:1952512501
Name:ROSKAMP FOUNDATION IRRV TR
Entity Type:Organization
Organization Name:ROSKAMP FOUNDATION IRRV TR
Other - Org Name:ROSKMAP INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARSONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-752-2949
Mailing Address - Street 1:2040 WHITFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-3922
Mailing Address - Country:US
Mailing Address - Phone:941-752-2949
Mailing Address - Fax:
Practice Address - Street 1:10770 N 46TH ST
Practice Address - Street 2:STE C-900
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-3442
Practice Address - Country:US
Practice Address - Phone:813-979-2008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34871Medicare ID - Type Unspecified