MEDICARE: WHOLLY ROMAN EMPIRE INC

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	335E00000X	Prosthetic/Orthotic Supplier		IL
2	335E00000X	Prosthetic/Orthotic Supplier		IL

General Provider Information

NPI Number	:	1689671398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLLY ROMAN EMPIRE INC

Provider Business Mailing Address
First Line	:	5956 DOVER RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61109-1733
Country	:	US
Telephone Number	:	773-586-2222
Fax Number	:	773-586-5566

Provider Business Practice Location Address
First Line	:	6655 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2419
Country	:	US
Telephone Number	:	773-586-2222
Fax Number	:	773-586-5566

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDWARD J ROMAN II
Credential	:
Telephone Number	:	773-586-2222

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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