MEDICARE: ANN E ROBERTS MD PSC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1760414197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN E ROBERTS MD PSC

Provider Business Mailing Address
First Line	:	1031 NEW MOODY LANE
Second Line	:	STE 200
City	:	LAGRANGE
State	:	KY
Zip	:	40031
Country	:	US
Telephone Number	:	502-222-3312
Fax Number	:	502-222-2217

Provider Business Practice Location Address
First Line	:	1031 NEW MOODY LANE
Second Line	:	STE 200
City	:	LAGRANGE
State	:	KY
Zip	:	40031
Country	:	US
Telephone Number	:	502-222-3312
Fax Number	:	502-222-2217

Authorized Official
Title or Position	:	OWNER PRES
Name	:	ANN E ROBERTS
Credential	:	MD
Telephone Number	:	502-222-3312

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	08/22/2020

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