Provider Demographics
NPI:1659374270
Name:ARLETTA A ROBERTS DBA HOLIDAES MEDICAL CONNECTION
Entity Type:Organization
Organization Name:ARLETTA A ROBERTS DBA HOLIDAES MEDICAL CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LETA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-266-9962
Mailing Address - Street 1:1151 GLENDA ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-2301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:281-485-0409
Practice Address - Street 1:1151 GLENDA ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-2301
Practice Address - Country:US
Practice Address - Phone:281-485-0409
Practice Address - Fax:281-485-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0066672332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157111901Medicaid
TX157111901,02,03OtherCHC - DME SUPPLIER
TX531627OtherBCBS OF TX - DME SUPPLIER
TX157111903Medicaid
TX157111902Medicaid
TX236953OtherAMERIGROUP - DME SUPPLIER
TX605791700OtherOWCP- DME SUPPLIER
TX157111901Medicaid
TX=========001OtherMILITARY HEALTHCARE SERV
TX605791700OtherOWCP- DME SUPPLIER