ROBERTA'S LOVELY LADIES BOUTIQUE (NPI# 1174983050) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174983050 |
| Entity Type | Organization |
| Organization Name | ROBERTA'S LOVELY LADIES BOUTIQUE |
| Practice Address |
603 W. Delmar Alton IL 62002 |
| Practice Telephone | 6184670640 |
| Mailing Telephone | 6184670640 |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2016-03-04 |
| Authorized Official Name | MRS. CAROL A LOGAN (OWNER) |
| Authorized Official Telephone | 6184670095 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 224900000X | Mastectomy Fitter | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
603 W. DELMAR |
| City | ALTON |
| State | IL |
| Zip Code | 62002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285272807 | Jersey Community Hospital | Obstetrics & Gynecology | #2 Memorial Drive, Suite 203, Alton, IL 62002 | 2019-12-13 |
| 1912540659 | Kelsi N Harre | Community Health Worker | 2603 N. Rogers Ave., Alton, IL 62002 | 2019-10-25 |
| 1841848322 | Destiny L Miller | Technician | 3429 Meridocia St, Alton, IL 62002 | 2019-08-28 |
| 1942854633 | Jessica Leigh Jump | Speech-Language Pathologist | 453 Bluff Street, Alton, IL 62002 | 2019-07-30 |
| 1194380741 | Vasiliki Kytridou | Dentist | 2800 College Avenue Southern Il University School of De, Building 285, Alton, IL 62002 | 2019-05-08 |
| 1982125910 | Amy Nicole Spalding | Social Worker | 1123 Harrison St, Alton, IL 62002 | 2017-06-29 |
| 1962856310 | Patricia Gregory | Social Worker | 5090 Humbert Rd, Alton, IL 62002 | 2016-04-21 |
| 1447612510 | Alanna Lynn Mcnelly | Chiropractor | 219 Piasa St, Suite 200, Alton, IL 62002 | 2016-03-28 |
| 1184081556 | Darcy Graham | Nurse Practitioner | 4 Memorial Dr # 210, Alton, IL 62002 | 2016-01-15 |
| 1104247741 | Alexandria Ruzicka | Physician Assistant | 4411 Alby Street, Alton, IL 62002 | 2013-12-29 |
| Find all providers in zip 62002 | ||||
| Taxonomy Code | 224900000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Mastectomy Fitter |
| An individual trained in the fitting and adjusting of breast prostheses and management of post-mastectomy prostheses services. |
| Notes: Source: National Uniform Claim Committee [7/1/2010: new] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740553262 | Linda K. Simons | Mastectomy Fitter | 117 N 6th St, Quincy, IL 62301-2903 | 2012-02-14 |
Please comment or provide details below to improve the information on ROBERTA'S LOVELY LADIES BOUTIQUE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.