Provider Demographics
NPI:1730367707
Name:ROCHE INSULIN DELIVERY SYSTEMS, INC.
Entity type:Organization
Organization Name:ROCHE INSULIN DELIVERY SYSTEMS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BUSINESS OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-521-0108
Mailing Address - Street 1:11800 EXIT 5 PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7988
Mailing Address - Country:US
Mailing Address - Phone:800-280-7801
Mailing Address - Fax:317-570-5309
Practice Address - Street 1:6650 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4809
Practice Address - Country:US
Practice Address - Phone:800-280-7801
Practice Address - Fax:317-570-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0690380001Medicare PIN