1467538801 NPI number — JOHN DAVID ROGERS

Table of content: (NPI 1467538801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467538801 NPI number — JOHN DAVID ROGERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN DAVID ROGERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KINETIC HEALTH CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467538801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 638
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIPLEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25271-0638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-926-0870
Provider Business Mailing Address Fax Number:
304-926-0871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 KANAWHA BLVD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25301-2511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-926-0870
Provider Business Practice Location Address Fax Number:
307-926-0871
Provider Enumeration Date:
10/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-720-6210

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0147774000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001815468 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 611531800 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 90008525 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2027096 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".