Provider Demographics
NPI:1235309030
Name:ROBERSONLTD
Entity Type:Organization
Organization Name:ROBERSONLTD
Other - Org Name:PARK HILL FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLEZETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:702-871-3730
Mailing Address - Street 1:3211 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1953
Mailing Address - Country:US
Mailing Address - Phone:702-871-3730
Mailing Address - Fax:702-871-7379
Practice Address - Street 1:3211 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1953
Practice Address - Country:US
Practice Address - Phone:702-871-3730
Practice Address - Fax:702-871-7379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NV546363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2402116Medicaid
NVV105718Medicare UPIN
NVV105718Medicare PIN