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General NPI Number Information
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NPI Number | 1306881263
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Entity Type | Organization
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Legal Business Name | ROTHALL, INC.
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 1951 LAKE AVE
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City | PUEBLO
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State | CO
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Zip | 81004-3321
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Country | US
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Telephone | 719-564-5333
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Fax | 719-564-6133
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Provider Business Mailing Address
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Address Line | 1951 LAKE AVE
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City | PUEBLO
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State | CO
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Zip | 81004-3321
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Country | US
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Telephone | 719-564-5333
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Fax | 719-564-6133
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD W ROTH
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Credential |
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Telephone | 719-564-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 03-49440-0000
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License Number State | CO
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