Basic Information
| Provider Information | |||||||||
| NPI: | 1225408073 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | MEADOWS | ||||||||
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| Credential: | HIF | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 E. SUNSET ROAD | ||||||||
| Address2: | UNIT 96595 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891931246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027980113 | ||||||||
| FaxNumber: | 8662915242 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 RILEY ST | ||||||||
| Address2: | |||||||||
| City: | GADSDEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359015432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565472373 | ||||||||
| FaxNumber: | 2565475353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2015 | ||||||||
| LastUpdateDate: | 10/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 2275 | AL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.