Provider Demographics
NPI:1942305727
Name:DR. JOHN Y. ROBERTSON FAMILY MEDICINE INC.
Entity Type:Organization
Organization Name:DR. JOHN Y. ROBERTSON FAMILY MEDICINE INC.
Other - Org Name:ROBERTSON FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-366-1648
Mailing Address - Street 1:1478 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3687
Mailing Address - Country:US
Mailing Address - Phone:740-366-1648
Mailing Address - Fax:740-366-1528
Practice Address - Street 1:1478 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3687
Practice Address - Country:US
Practice Address - Phone:740-366-1648
Practice Address - Fax:740-366-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2497927Medicaid
OHRO4142171Medicare UPIN
OH1770571804Medicare PIN
OH2497927Medicaid
OH9347151Medicare PIN
OH2497927Medicaid
OH2672095Medicaid