Provider Demographics
NPI:1134545122
Name:STACI L ROSCHE PC
Entity type:Organization
Organization Name:STACI L ROSCHE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STACI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-650-5811
Mailing Address - Street 1:13906 GOLD CIR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2335
Mailing Address - Country:US
Mailing Address - Phone:402-932-6500
Mailing Address - Fax:888-381-0698
Practice Address - Street 1:13906 GOLD CIR
Practice Address - Street 2:SUITE 202
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2335
Practice Address - Country:US
Practice Address - Phone:402-932-6500
Practice Address - Fax:888-381-0698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE245162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty