Provider Demographics
NPI:1447467287
Name:JOHN ROBERTS ENTERPRISES INC
Entity type:Organization
Organization Name:JOHN ROBERTS ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPO
Authorized Official - Phone:814-944-0187
Mailing Address - Street 1:3500 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-1814
Mailing Address - Country:US
Mailing Address - Phone:814-944-0187
Mailing Address - Fax:814-942-1712
Practice Address - Street 1:249 HOSPITAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7020
Practice Address - Country:US
Practice Address - Phone:814-623-9977
Practice Address - Fax:814-623-1467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1266670004Medicare ID - Type Unspecified