Organization
SOUTHERN IOWA GENERAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL ROLESON DO (PRESIDENT CEO)
(515) 237-3974
Entity
Organization
Contact information
Practice address
105 E MCLANE ST, SUITE 400, OSCEOLA, IA 50213-1456
(641) 342-6337
(641) 342-6339
Mailing address
2213 GRAND AVE, DES MOINES, IA 50312-5305
(515) 237-3974
(515) 883-2692
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02987
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0400207
—
IA
Enumeration date
06/28/2007
Last updated
10/29/2007
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