MEDICARE: ARLETTA A ROBERTS DBA HOLIDAES MEDICAL CONNECTION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0066672	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	157111901,02,03	OTHER	TX	CHC - DME SUPPLIER
3	531627	OTHER	TX	BCBS OF TX - DME SUPPLIER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	236953	OTHER	TX	AMERIGROUP - DME SUPPLIER
7	605791700	OTHER	TX	OWCP- DME SUPPLIER

General Provider Information

NPI Number	:	1659374270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARLETTA A ROBERTS DBA HOLIDAES MEDICAL CONNECTION

Provider Business Mailing Address
First Line	:	1151 GLENDA ST
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77581-2301
Country	:	US
Telephone Number	:
Fax Number	:	281-485-0409

Provider Business Practice Location Address
First Line	:	1151 GLENDA ST
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77581-2301
Country	:	US
Telephone Number	:	281-485-0409
Fax Number	:	281-485-0409

Authorized Official
Title or Position	:	OWNER
Name	:	LETA ROBERTS
Credential	:
Telephone Number	:	832-266-9962

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	06/15/2008

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