1578512190 NPI number — GEORGE M RODGERS M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578512190 NPI number — GEORGE M RODGERS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODGERS
Provider First Name:
GEORGE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1578512190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 413033
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84141-3033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-213-3900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1950 CIRCLE OF HOPE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84112-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-2121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  178034-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 178034-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZH0000X , with the licence number: 178034-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0000X , with the licence number: 178034-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002088271 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110027831 . This is a "MEDICARE RAILROAD #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2235 . This is a "UNIVERSITY HEALTH PLANS #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870442845R01 . This is a "EMIA #" identifier . This identifiers is of the category "OTHER".
  • Identifier: PRA01461 . This is a "MOLINA #" identifier . This identifiers is of the category "OTHER".
  • Identifier: QM0000008689 . This is a "ALTIUS #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6488 . This is a "DMBA #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09149 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107005338104 . This is a "IHC #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003039200 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107005338H05 . This is a "IHC HUNTSMAN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21435 . This is a "PEHP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3000010 . This is a "UNITED HEALTH CARE #" identifier . This identifiers is of the category "OTHER".




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