| J R Roberts Medical Inc | |
|
1616 E 56th St Unit 1203 Chicago IL 60637-2710 | |
| (312) 890-0809 | |
| Not Available |
| Full Name | J R Roberts Medical Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1616 E 56th St Unit 1203, Chicago, Illinois |
| Authorized Official Name and Position | Julia R Roberts (PRESIDENT) |
| Authorized Official Contact | 3128900809 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J R Roberts Medical Inc 1616 E 56th St Unit 1203 Chicago IL 60637-2710 Ph: (312) 890-0809 | J R Roberts Medical Inc 1616 E 56th St Unit 1203 Chicago IL 60637-2710 Ph: (312) 890-0809 |
| NPI Number | 1922731637 |
|---|---|
| Provider Enumeration Date | 07/08/2022 |
| Last Update Date | 07/08/2022 |
| Medicare PECOS PAC ID | 1658755723 |
|---|---|
| Medicare Enrollment ID | O20220908003323 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922731637 | NPI | - | NPPES |
| 036073364 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Julia R Roberts |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1376528802 PECOS PAC ID: 8921066606 Enrollment ID: I20070502000064 |
| Provider Name | Leroy M Lambey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548754039 PECOS PAC ID: 9830448885 Enrollment ID: I20180823002743 |
| Provider Name | Arlette Meffo Tiam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548808801 PECOS PAC ID: 7113357781 Enrollment ID: I20200422001616 |
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