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	282NW0100X	Women's Hospital	12300	MS

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
2	000020225	OTHER	MS	BLUE CROSS

General Provider Information

NPI Number	:	1285681841
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	:	601-933-6401
Fax Number	:	601-936-3086

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	:	DIRECTOR/DELEGATED OFFICIAL
Name	:	PAULA LALOR
Credential	:
Telephone Number	:	629-215-3953

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	04/21/2021

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Directions to “ROH LLC ” Practice Location

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