MEDICARE: ROGER DOMINIQUE CARTER SR.

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	343900000X	Non-emergency Medical Transport (VAN)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063112522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER DOMINIQUE CARTER SR.

Provider Business Mailing Address
First Line	:	6240 STOCKTON TRAIL WAY
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-4464
Country	:	US
Telephone Number	:	614-537-9808
Fax Number	:

Provider Business Practice Location Address
First Line	:	6240 STOCKTON TRAIL WAY
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-4464
Country	:	US
Telephone Number	:	614-537-9808
Fax Number	:

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

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	03/03/2023

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