EVAN ROUBAL (NPI# 1043571904) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043571904 |
| Entity Type | Individual |
| Full Name | EVAN ROUBAL |
| Practice Address |
12054 Mississippi Dr N Champlin MN 55316-2110 |
| Mailing Address |
12054 Mississippi Drive Champlin MN 55316 |
| Practice Telephone | 7607255298 |
| Mailing Telephone | 7607255298 |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2012-06-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| Street Address |
12054 MISSISSIPPI DR N |
| City | CHAMPLIN |
| State | MN |
| Zip Code | 55316-2110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801493903 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 11995 Business Park Blvd N, Champlin, MN 55316 | 2020-10-02 |
| 1598300675 | Dentalign, Pa | Dentist | 11942 Business Park Blvd, Champlin, MN 55316 | 2019-11-12 |
| 1811463573 | Vikings Home Health Care LLC | Meals | 11551 Georgia Ave, N, Champlin, MN 55316 | 2018-10-22 |
| 1255853305 | Matthew L Boelter | Hearing Instrument Specialist | 11451 Oregon Ave N, Champlin, MN 55316 | 2017-07-11 |
| 1194198309 | Champlin Dentistry, PC | Dentist | 11231 Aquila Drive N, Champlin, MN 55316 | 2015-11-10 |
| 1336557412 | Kelsey Voigt | Pharmacist | 11990 Business Park Blvd, Champlin, MN 55316 | 2014-08-01 |
| 1346502523 | Transitions Home Care Ltd | Home Health | 11030 Douglas Drive North, Champlin, MN 55316 | 2012-06-13 |
| 1639373285 | Michael D Smilanich | Dentist | 11231 Aquila Dr N, Champlin, MN 55316 | 2007-06-14 |
| 1760532907 | Kurt Allan Bender | Dentist | 500 A Jefferson Hwy, Champlin, MN 55316 | 2007-01-11 |
| 1366529752 | Gregory Allan Holmberg | Chiropractor | #8 3rd Street Nw, Osseo, MN 55316 | 2006-11-01 |
| Find all providers in zip 55316 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174738793 | Mark Allen Taylor | Military Health Care Provider | 5905 34th Ave S, Minneapolis, MN 55450-2900 | 2007-05-14 |
| 1225400104 | Elias Cedillo Iv | Military Health Care Provider | 5905 34th Ave S, Minneapolis, MN 55450-2900 | 2015-10-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.