1295953156 NPI number — GERALD W ROGERS M.A.,M.S.W.,PHD,P.A.

Table of content: (NPI 1295953156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295953156 NPI number — GERALD W ROGERS M.A.,M.S.W.,PHD,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERALD W ROGERS M.A.,M.S.W.,PHD,P.A.
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:
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:
1295953156
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 50660
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79159-0660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-354-9996
Provider Business Mailing Address Fax Number:
806-354-9995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7480 GOLDEN POND SUITE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-354-9996
Provider Business Practice Location Address Fax Number:
806-354-9995
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
LICENSED CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
806-354-9996

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11662504 . This is a "CAQH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1952499451 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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