# RACC MEDICAL ASSOCIATES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Summit Pain Management
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184976136
- **Authorized official:** DANIEL C ROTH DO (OWNER)
- **Authorized official phone:** (260) 748-3650

## Contact information

- **Practice address:** 1721 MAGNAVOX WAY, FORT WAYNE, IN 46804-1537
- **Practice address phone:** (260) 748-3650
- **Practice address fax:** (260) 748-3651
- **Mailing address:** 1721 MAGNAVOX WAY, STE B, FORT WAYNE, IN 46804-1537
- **Mailing address phone:** (260) 748-3650
- **Mailing address fax:** (260) 748-3651

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 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