Provider Demographics
NPI:1568545143
Name:KENNETH C ROBERTS DO APMC
Entity Type:Organization
Organization Name:KENNETH C ROBERTS DO APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-324-7332
Mailing Address - Street 1:PO BOX 850299
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:KS
Mailing Address - Zip Code:73085-0299
Mailing Address - Country:US
Mailing Address - Phone:405-324-7332
Mailing Address - Fax:
Practice Address - Street 1:95 E FAIRWAY DRIVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-966-3757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F83536JMedicare UPIN
LA5U433CF98Medicare ID - Type Unspecified