Provider Demographics
NPI:1710980156
Name:ROCHE DIABETES CARE INC
Entity Type:Organization
Organization Name:ROCHE DIABETES CARE INC
Other - Org Name:ROCHE DIABETES CARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, ROCHE DIABETES CARE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-521-2000
Mailing Address - Street 1:9115 HAGUE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1025
Mailing Address - Country:US
Mailing Address - Phone:317-521-2000
Mailing Address - Fax:
Practice Address - Street 1:9115 HAGUE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1025
Practice Address - Country:US
Practice Address - Phone:317-521-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69001332A332B00000X
IN60006506A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2025455OtherPK
IN7468410001Medicare NSC