Provider Demographics
NPI:1700081783
Name:ROMAN SAFAROV
Entity Type:Organization
Organization Name:ROMAN SAFAROV
Other - Org Name:ROMAN'S REPAIR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAFAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-746-0857
Mailing Address - Street 1:1521 OLD LOUISVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1279
Mailing Address - Country:US
Mailing Address - Phone:270-746-0857
Mailing Address - Fax:270-746-2358
Practice Address - Street 1:1521 OLD LOUISVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1279
Practice Address - Country:US
Practice Address - Phone:270-746-0857
Practice Address - Fax:270-746-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies