Provider Demographics
NPI:1174072854
Name:JEFFREY T ROITH
Entity type:Organization
Organization Name:JEFFREY T ROITH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:913-894-4040
Mailing Address - Street 1:10600 QUIVIRA RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2314
Mailing Address - Country:US
Mailing Address - Phone:913-894-4040
Mailing Address - Fax:913-438-4725
Practice Address - Street 1:10600 QUIVIRA RD
Practice Address - Street 2:SUITE 220
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2314
Practice Address - Country:US
Practice Address - Phone:913-894-4040
Practice Address - Fax:913-438-4725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00424213ES0103X
KS12-00235213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty