Provider Demographics
NPI:1962725960
Name:VICKI LYNN ROFF
Entity type:Organization
Organization Name:VICKI LYNN ROFF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-333-5000
Mailing Address - Street 1:6248 BALSAM RD NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-7728
Mailing Address - Country:US
Mailing Address - Phone:218-751-0674
Mailing Address - Fax:218-759-1715
Practice Address - Street 1:1231 5TH STREET NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601
Practice Address - Country:US
Practice Address - Phone:218-751-3196
Practice Address - Fax:218-759-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 124141-5163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty