Provider Demographics
NPI:1679338388
Name:ANGELA ROGERS FAMILY PRACTICE
Entity type:Organization
Organization Name:ANGELA ROGERS FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:937-538-1884
Mailing Address - Street 1:1134 HAGER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2423
Mailing Address - Country:US
Mailing Address - Phone:937-538-1884
Mailing Address - Fax:
Practice Address - Street 1:1134 HAGER ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2423
Practice Address - Country:US
Practice Address - Phone:937-538-1884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care