MEDICARE: ROACH ENTERPRISES 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	332B00000X	Durable Medical Equipment & Medical Supplies

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	:	1952677080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROACH ENTERPRISES INC

Provider Business Mailing Address
First Line	:	50 FRISCO ST
Second Line	:
City	:	MARKED TREE
State	:	AR
Zip	:	72365-2214
Country	:	US
Telephone Number	:	870-358-2484
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 FRISCO ST
Second Line	:
City	:	MARKED TREE
State	:	AR
Zip	:	72365-2214
Country	:	US
Telephone Number	:	870-358-2484
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONNI J ROACH
Credential	:	PD
Telephone Number	:	870-358-2484

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	03/22/2012

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Directions to “ROACH ENTERPRISES INC ” Practice Location

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