Charles Anthony Roberts Jr., PAC
Individual provider Active NPI Physician Assistant · Veneta, OR
NPI 1437166352 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1437166352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA00257 (OR)
- Practice address
- 87983 Territorial Rd
Veneta, OR 97487 - Phone
- (541) 935-2200
- Fax
- (541) 935-6241
- NPI assigned
- Aug 2, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Icco, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00257 | OR | Yes |
Addresses
Primary practice location
87983 Territorial Rd
Veneta, OR 97487
Mailing address
PO Box 145
Veneta, OR 97487-0145
Phone (541) 935-2200
Other providers in Veneta, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.