MEDICARE: ROCHE HEALTH SOLUTIONS 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	0105509540	IN
2	293D00000X	Physiological Laboratory	0105509540	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	236589	OTHER	NJ	MEDICARE PTAN

General Provider Information

NPI Number	:	1962712224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCHE HEALTH SOLUTIONS INC.

Provider Business Mailing Address
First Line	:	9115 HAGUE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-1025
Country	:	US
Telephone Number	:	800-280-7801
Fax Number	:	888-810-0758

Provider Business Practice Location Address
First Line	:	150 CLOVE RD
Second Line	:	SUITE 8
City	:	LITTLE FALLS
State	:	NJ
Zip	:	07424-2138
Country	:	US
Telephone Number	:	888-803-8936
Fax Number	:	888-810-0758

Authorized Official
Title or Position	:	DIRECTOR, ROCHE HEALTH SOLUTIONS
Name	:	MR. DENVER K SHAFFER
Credential	:
Telephone Number	:	317-521-2000

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	04/24/2017

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