1497799878 NPI number — DR. KEVIN G ROBERTS D.C.

Table of content: DR. KEVIN G ROBERTS D.C. (NPI 1497799878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497799878 NPI number — DR. KEVIN G ROBERTS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
KEVIN
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497799878
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICKTOWN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63645-0189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-783-3188
Provider Business Mailing Address Fax Number:
573-783-3314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
713 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKTOWN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63645-1113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-783-3188
Provider Business Practice Location Address Fax Number:
573-783-3314
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  004431 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 106834 . This is a "HEALTHLINK ID #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 12362 . This is a "BLUE CROSS ID #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0497085 . This is a "HEALTHLINK ID #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4407100 . This is a "UNITED HEALTHCARE ID #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0497085 . This is a "CIGNA ID #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000013947 . This is a "MEDICARE GROUP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 752824805 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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