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Organization
RACC MEDICAL ASSOCIATES LLC
Active
Organization
RACC MEDICAL ASSOCIATES LLC
Active
Other names
Summit Pain Management
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL C ROTH DO (OWNER)
(260) 748-3650
Entity
Organization
Contact information
Practice address
1721 MAGNAVOX WAY, FORT WAYNE, IN 46804-1537
(260) 748-3650
(260) 748-3651
Mailing address
1721 MAGNAVOX WAY, STE B, FORT WAYNE, IN 46804-1537
(260) 748-3650
(260) 748-3651
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
NULL
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
NULL
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
Other
Enumeration date
10/15/2012
Last updated
11/05/2024
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