Provider Demographics
NPI:1801980842
Name:ROXANNE L KRAMER
Entity type:Organization
Organization Name:ROXANNE L KRAMER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-764-2888
Mailing Address - Street 1:435 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-1347
Mailing Address - Country:US
Mailing Address - Phone:309-764-2888
Mailing Address - Fax:309-764-3294
Practice Address - Street 1:435 17TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-1347
Practice Address - Country:US
Practice Address - Phone:309-764-2888
Practice Address - Fax:309-764-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08121233OtherBLUE CROSS BLUE SHIELD
IA99893OtherWELLMARK BC OF IA
IL08121233OtherBLUE CROSS BLUE SHIELD
IA99893OtherWELLMARK BC OF IA