MEDICARE: ROH 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1285254789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROH LLC

Provider Business Mailing Address
First Line	:	1026 N FLOWOOD DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39232-9532
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1026 N FLOWOOD DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39232-9532
Country	:	US
Telephone Number	:	601-933-6401
Fax Number	:	601-396-3086

Authorized Official
Title or Position	:	VP PHYSICIAN BUSINESS SERVICES
Name	:	JAMES P WRIGHT
Credential	:
Telephone Number	:	615-778-1502

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	04/24/2020

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Directions to “ROH LLC ” Practice Location

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