=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508680844
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROPER ST FRANCIS ANCILLARY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2024
-----------------------------------------------------
Last Update Date | 11/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8536 PALMETTO COMMERCE PKWY STE 207A
-----------------------------------------------------
City | LADSON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29456-6700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-402-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8536 PALMETTO COMMERCE PKWY STE 207A
-----------------------------------------------------
City | LADSON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29456-6700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-402-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP REIMBURSEMENT
-----------------------------------------------------
Name | KIMBERLY M RALSTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-996-5119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------