MEDICARE: ROGER HEMMING CONTRACTOR, LLC

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	171W00000X	Contractor
2	171WH0202X	Home Modifications Contractor

General Provider Information

NPI Number	:	1013755891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGER HEMMING CONTRACTOR, LLC

Provider Business Mailing Address
First Line	:	22115 STATE ROUTE 73
Second Line	:
City	:	WEST PORTSMOUTH
State	:	OH
Zip	:	45663-6366
Country	:	US
Telephone Number	:	740-858-6761
Fax Number	:

Provider Business Practice Location Address
First Line	:	22115 STATE ROUTE 73
Second Line	:
City	:	WEST PORTSMOUTH
State	:	OH
Zip	:	45663-6366
Country	:	US
Telephone Number	:	740-858-6761
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DEBRA OLIVER
Credential	:
Telephone Number	:	740-858-6761

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	07/17/2024

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