1043408578 NPI number — DR. MAILIEN REED ROGERS D.O.

Table of content: DR. MAILIEN REED ROGERS D.O. (NPI 1043408578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043408578 NPI number — DR. MAILIEN REED ROGERS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
MAILIEN
Provider Middle Name:
REED
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1043408578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111H BUILDING 8 DOGWOOD AVENUE
Provider Second Line Business Mailing Address:
PO BOX 4000 JAMES H QUILLEN VA MEDICAL CENTER
Provider Business Mailing Address City Name:
MOUNTAIN HOME
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-926-1171
Provider Business Mailing Address Fax Number:
423-979-3609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 MCFARLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37814-3992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-621-6250
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2007

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: 207RX0202X , with the licence number:  2083 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q055396 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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