Healthcare Provider Details

I. General information

NPI: 1205388618
Provider Name (Legal Business Name): ROPER HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 03/17/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CALLEN BLVD STE 220
SUMMERVILLE SC
29486-2816
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2289
  • Fax: 843-606-8038
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: MR. WILLIAM ANTHONY JACKSON
Title or Position: CEO
Credential:
Phone: 843-724-2954