1649266693 NPI number — MRS. ROSE INGRAM OGLE LCSW

Table of content: MRS. ROSE INGRAM OGLE LCSW (NPI 1649266693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649266693 NPI number — MRS. ROSE INGRAM OGLE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGLE
Provider First Name:
ROSE
Provider Middle Name:
INGRAM
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATTHEWS
Provider Other First Name:
ROSE
Provider Other Middle Name:
INGRAM
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649266693
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1559
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARTOW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33831-1559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-519-0575
Provider Business Mailing Address Fax Number:
863-534-7028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 E ORANGE ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
WAUCHULA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33873-2934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-773-3228
Provider Business Practice Location Address Fax Number:
863-534-7028
Provider Enumeration Date:
09/26/2005

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: 1041C0700X , with the licence number:  SW2870 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Z955 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 763558300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 455343000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 763558300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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