1255828976 NPI number — MADELINE CHRISTINE ROGERS BS

Table of content: MADELINE CHRISTINE ROGERS BS (NPI 1255828976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255828976 NPI number — MADELINE CHRISTINE ROGERS BS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
MADELINE
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS
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:
1255828976
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19800 VILLAGE OFFICE CT. SUITE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-306-3483
Provider Business Mailing Address Fax Number:
541-639-8909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1170 PEARL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-3541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-743-4340
Provider Business Practice Location Address Fax Number:
541-743-4369
Provider Enumeration Date:
04/18/2018

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: 106S00000X , with the licence number:  ABA-IN-10204626 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ABA-IN-10204626 . This is a "STATE REGISTRATION" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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