Provider Demographics
NPI:1073695896
Name:ROADRUNNER MOBILITY INC
Entity Type:Organization
Organization Name:ROADRUNNER MOBILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-467-2668
Mailing Address - Street 1:39400 TAYLOR PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6263
Mailing Address - Country:US
Mailing Address - Phone:800-467-2668
Mailing Address - Fax:866-362-1367
Practice Address - Street 1:39400 TAYLOR PKWY
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44035-6263
Practice Address - Country:US
Practice Address - Phone:800-467-2668
Practice Address - Fax:866-362-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146819101Medicaid
TX95959OtherPACIFICARE OF TEXAS
AL009974800Medicaid
IL749952024001Medicaid
KY90008343Medicaid
TX531005OtherBLUE CROSS BLUE SHIELD
TX146818301Medicaid
OK200031200AMedicaid
TN4582231Medicaid
MS00440883Medicaid
LA1108341Medicaid
AR145445716Medicaid
IN200819000AMedicaid
NMN1406Medicaid
CT003135432Medicaid
NMN1406Medicaid