Basic Information
| Provider Information | |||||||||
| NPI: | 1396105136 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROGERS HEARING HEALTHCARE, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AUDIBEL HEARING HEALTHCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17167 | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394047167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012615995 | ||||||||
| FaxNumber: | 6012615335 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 HARDY ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394021696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012615995 | ||||||||
| FaxNumber: | 6012615335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2016 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROGERS | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | JACKSON | ||||||||
| AuthorizedOfficialTitleorPosition: | AUDIOLOGIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6012615995 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA,CCC-A, FAAA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0700X | 1021A | AL | N | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech | 261QH0700X | 4535 | LA | N | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech | 261QH0700X | A3163 | MS | Y | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech |
ID Information
| ID | Type | State | Issuer | Description | 512I640023 | 01 | MS | MEDICARE PTAN | OTHER | 04979391 | 05 | MS | MEDICAID |