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General NPI Number Information
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NPI Number | 1376621540
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Entity Type | Organization
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Legal Business Name | JOHN DAVID ROGERS
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2200 GRAND CENTRAL AVE SUITE 105
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City | VIENNA
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State | WV
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Zip | 26105-1300
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Country | US
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Telephone | 304-295-6041
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Fax | 304-295-6182
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Provider Business Mailing Address
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Address Line | PO BOX 638
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City | RIPLEY
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State | WV
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Zip | 25271-0638
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Country | US
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Telephone | 304-926-0870
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN D ROGERS
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Credential |
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Telephone | 304-926-0870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State | WV
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