Provider Demographics
| NPI: | 1366591703 |
|---|---|
| Name: | ROPER HOSPITAL, INC. |
| Entity type: | Organization |
| Organization Name: | ROPER HOSPITAL, INC. |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | BRET |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | JOHNSON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 843-724-2946 |
| Mailing Address - Street 1: | PO BOX 751649 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CHARLOTTE |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 28275-1649 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 843-789-1620 |
| Mailing Address - Fax: | 843-724-2454 |
| Practice Address - Street 1: | 125 DOUGHTY ST |
| Practice Address - Street 2: | SUITE 400 |
| Practice Address - City: | CHARLESTON |
| Practice Address - State: | SC |
| Practice Address - Zip Code: | 29403-5736 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 843-789-1620 |
| Practice Address - Fax: | 843-724-2454 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-01-08 |
| Last Update Date: | 2008-01-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| SC | TL29749 | 207RG0300X |
| SC | TL30258 | 207RG0300X |
| SC | 000520 | 103G00000X |
| SC | 19311 | 2080N0001X |
| SC | 27482 | 2086S0129X |
| 261QR0200X | ||
| SC | APN2541 | 363L00000X |
| SC | 00048029 | 363LN0000X |
| SC | 22489 | 207R00000X |
| SC | 20903 | 207XS0106X |
| SC | 520 | 103G00000X |
| SC | 19281 | 208G00000X |
| SC | 22518 | 207Q00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | Group - Multi-Specialty |
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | Group - Multi-Specialty |
| No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
| No | 261QR0200X | Ambulatory Health Care Facilities | Clinic/Center | Radiology | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LN0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal | Group - Multi-Specialty |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| SC | CF9180 | Other | RR MEDICARE |
| SC | GP1400 | Medicaid | |
| SC | GP3299 | Medicaid | |
| SC | GP3787 | Medicaid | |
| SC | GP4799 | Medicaid | |
| SC | CH8347 | Other | RR MEDICARE |
| SC | GP4051 | Medicaid | |
| SC | GP3572 | Medicaid | |
| SC | GP4466 | Medicaid | |
| SC | 5329 | Medicare ID - Type Unspecified | GROUP |
| SC | GP3299 | Medicaid | |
| SC | GP4051 | Medicaid |
