Provider Demographics
NPI:1417912668
Name:ROBERTS ORTHOTICS & PROSTHETICS
Entity Type:Organization
Organization Name:ROBERTS ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:BOCOP
Authorized Official - Phone:724-627-4600
Mailing Address - Street 1:244 ELM DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8269
Mailing Address - Country:US
Mailing Address - Phone:724-627-4600
Mailing Address - Fax:724-627-4606
Practice Address - Street 1:244 ELM DR
Practice Address - Street 2:SUITE 104
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8269
Practice Address - Country:US
Practice Address - Phone:724-627-4600
Practice Address - Fax:724-627-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA123485Medicaid
PA219555OtherBLUE CROSS/BLUE SHIELD
PA001823780002Medicaid
WV6204003000Medicaid
PA3888090001Medicare NSC