MEDICARE: ROPER'S HEALTH OASIS

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	363LF0000X	Family

General Provider Information

NPI Number	:	1366939324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROPER'S HEALTH OASIS

Provider Business Mailing Address
First Line	:	PO BOX 1226
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88221-1226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 S HALAGUENO ST STE 8
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-5748
Country	:	US
Telephone Number	:	575-725-5211
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANNON L ROPER
Credential	:
Telephone Number	:	575-941-2500

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	04/16/2018

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