1720035447 NPI number — M. ROGERS, INC. & SUBSIDIARY

Table of content: (NPI 1720035447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720035447 NPI number — M. ROGERS, INC. & SUBSIDIARY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M. ROGERS, INC. & SUBSIDIARY
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:
ROGERS PHARMACY
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:
1720035447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARKIO
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64491-1544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-736-5512
Provider Business Mailing Address Fax Number:
660-736-4361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARKIO
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64491-1544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-736-5512
Provider Business Practice Location Address Fax Number:
660-736-4361
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
BENNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
660-442-5694

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  003813 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X , with the licence number: 003813 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 600243422 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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