MEDICARE: ROPER HOSPITAL, INC

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	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1740802297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROPER HOSPITAL, INC

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:	843-724-2454

Provider Business Practice Location Address
First Line	:	3500 N HIGHWAY 17
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-9123
Country	:	US
Telephone Number	:	843-724-2289
Fax Number	:	843-606-8038

Authorized Official
Title or Position	:	CEO
Name	:	WILLIAM JACKSON
Credential	:
Telephone Number	:	843-724-2952

Provider Enumeration Date	:	05/07/2020
Last Update Date	:	11/27/2023

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