Provider Demographics
NPI:1801858378
Name:ROBERTS DME LLC
Entity Type:Organization
Organization Name:ROBERTS DME LLC
Other - Org Name:HAPPY FEET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-688-5888
Mailing Address - Street 1:510 E PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3125
Mailing Address - Country:US
Mailing Address - Phone:270-688-5888
Mailing Address - Fax:270-688-8238
Practice Address - Street 1:510 E PARRISH AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3125
Practice Address - Country:US
Practice Address - Phone:270-688-5888
Practice Address - Fax:270-688-8238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000313763OtherBC/BS
IN200443980AMedicaid
KY2444604000OtherPASSPORT ADVANTAGE
KY50002827OtherPASSPORT HEALTH PLAN
KY90006529Medicaid
KY4797060001Medicare ID - Type Unspecified
KY90006529Medicaid