Provider Demographics
NPI:1023010899
Name:JOHN ROBERTS ENTERPRISES
Entity Type:Organization
Organization Name:JOHN ROBERTS ENTERPRISES
Other - Org Name:ALLEGHENY ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
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 1:3500 6TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1814
Practice Address - Country:US
Practice Address - Phone:814-944-0187
Practice Address - Fax:814-942-1712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007654810004Medicaid
PA1007654810004Medicaid
PA1266670002Medicare ID - Type Unspecified
PA1266670003Medicare ID - Type Unspecified