Provider Demographics
NPI:1427019066
Name:ROTH MEDICAL INC
Entity Type:Organization
Organization Name:ROTH MEDICAL INC
Other - Org Name:ROTECH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MENCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-822-4600
Mailing Address - Street 1:PO BOX 27968
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0968
Mailing Address - Country:US
Mailing Address - Phone:765-448-6685
Mailing Address - Fax:765-446-4287
Practice Address - Street 1:177 CRAFT DR STE 104
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2248
Practice Address - Country:US
Practice Address - Phone:719-589-3889
Practice Address - Fax:719-589-3905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROTECH HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-31
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80155871Medicaid
CO0236290004Medicare NSC