Provider Demographics
NPI:1124271283
Name:VIP MEDICAL SERVICES
Entity type:Organization
Organization Name:VIP MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-427-0691
Mailing Address - Street 1:1012 IRVING RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3428
Mailing Address - Country:US
Mailing Address - Phone:205-427-0691
Mailing Address - Fax:
Practice Address - Street 1:608 STONE AVENUE
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35610-2217
Practice Address - Country:US
Practice Address - Phone:205-427-0691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-02
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL128722Medicaid
AL128722Medicaid
ALH58996Medicare UPIN