MEDICARE: ROODLY RICHARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	H518-028-995-714	MN

General Provider Information

NPI Number	:	1245932938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROODLY RICHARD

Provider Business Mailing Address
First Line	:	3203 75TH ST E
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-2579
Country	:	US
Telephone Number	:	651-560-0710
Fax Number	:

Provider Business Practice Location Address
First Line	:	3203 75TH ST E
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-2579
Country	:	US
Telephone Number	:	651-560-0710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/20/2023

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Directions to “ ROODLY RICHARD ” Practice Location

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