MEDICARE: ROPER SAINT FRANCIS PHYSICIANS NETWORK

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	208100000X	Physical Medicine & Rehabilitation Physician
2	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417419193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROPER SAINT FRANCIS PHYSICIANS NETWORK

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	888-472-0043
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	2145 HENRY TECKLENBURG DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5893
Country	:	US
Telephone Number	:	843-723-8823
Fax Number	:	843-606-8059

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT OLIVERIO
Credential	:
Telephone Number	:	843-724-2903

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	04/07/2026

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