Robertas Lovely Ladies Boutique

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

A1735 Issued in IL

Legal business name

ROBERTAS LOVELY LADIES BOUTIQUE

Practice address

603 West Delmar
Alton, IL 62002

Phone

(618) 467-0640

Fax

(618) 467-8819

NPI assigned

Apr 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Roberta J Jaynes

Title

Owner Sole Propietor

Phone

(618) 467-0640

Specialties & licenses 1

Addresses

Other identifiers 7

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carol Logan

  • Durable Medical Equipment & Medical Supplies
  • Alton, IL
  • NPI 1417318197
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434585600000",
    "number": "1376508309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 WEST DELMAR",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "62002",
            "telephone_number": "618-467-0640",
            "fax_number": "618-467-8819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 WEST DELMAR",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "62002",
            "telephone_number": "618-467-0640",
            "fax_number": "618-467-8819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERTAS LOVELY LADIES BOUTIQUE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2015-06-18",
        "status": "A",
        "authorized_official_last_name": "JAYNES",
        "authorized_official_first_name": "ROBERTA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER SOLE PROPIETOR",
        "authorized_official_telephone_number": "618-467-0640",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "A1735",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MO",
            "identifier": "137024",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2375728",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK OF IL",
            "identifier": "269893",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "L038503",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5824316",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL",
            "identifier": "06020694",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTI PLAN OF IL",
            "identifier": "BA7549138",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Riverbend Head Start & Family Services
• Riverbend Head Start & Family Services
• Miranda Walker Robbins, LCSW
• Regina Robeen, ASN,RN
• Roberta'S Lovely Ladies Boutique
• Bradley Wane Roberts, D.M.D.
• Kevin Brent Roberts, P.T.
• Sara B Roberts, RPH
• Janis M. Robinson, MD
• William P Robinson Jr., MD

• Durable Medical Equipment & Medical Supplies in Alton, IL
• Providers in Alton, IL by specialty
• Durable Medical Equipment & Medical Supplies in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.