Provider Demographics
NPI:1396700027
Name:ROBERTS, JOHN SHERMAN (CPO)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SHERMAN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-1507
Mailing Address - Country:US
Mailing Address - Phone:406-443-7743
Mailing Address - Fax:
Practice Address - Street 1:2121 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-1507
Practice Address - Country:US
Practice Address - Phone:406-443-7743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT510640Medicaid
MT0185640001Medicare NSC