Provider Demographics
NPI:1043616097
Name:ROBERTS, BILLY GENE
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:GENE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 S GRAVEL PIT RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62522-9720
Mailing Address - Country:US
Mailing Address - Phone:217-619-4395
Mailing Address - Fax:
Practice Address - Street 1:849 S GRAVEL PIT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62522-9720
Practice Address - Country:US
Practice Address - Phone:217-619-4395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies