MEDICARE: ROCHE INSULIN DELIVERY SYSTEMS, 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	332B00000X	Durable Medical Equipment & Medical Supplies	332B00000X	IN

General Provider Information

NPI Number	:	1730367707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCHE INSULIN DELIVERY SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	11800 EXIT 5 PKWY
Second Line	:	SUITE 120
City	:	FISHERS
State	:	IN
Zip	:	46037-7988
Country	:	US
Telephone Number	:	800-280-7801
Fax Number	:	317-570-5309

Provider Business Practice Location Address
First Line	:	6650 RIVERS AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4809
Country	:	US
Telephone Number	:	800-280-7801
Fax Number	:	317-570-5300

Authorized Official
Title or Position	:	DIRECTOR, BUSINESS OPERATIONS
Name	:	MR. HOWARD SAMS
Credential	:
Telephone Number	:	317-521-0108

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	04/21/2010

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