MEDICARE: KATHERINE DENISE ROOF

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1750640421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE DENISE ROOF

Provider Business Mailing Address
First Line	:	37 VILLA RD STE 300
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3038
Country	:	US
Telephone Number	:	864-271-4321
Fax Number	:	864-271-4473

Provider Business Practice Location Address
First Line	:	37 VILLA RD STE 300
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3038
Country	:	US
Telephone Number	:	864-271-4321
Fax Number	:	864-271-4473

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

Provider Enumeration Date	:	05/15/2012
Last Update Date	:	05/15/2012

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