Basic Information
| Provider Information | |||||||||
| NPI: | 1447792460 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | SETH | ||||||||
| MiddleName: | JOSHUA | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23070 | ||||||||
| Address2: | |||||||||
| City: | BARLING | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729230070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794525040 | ||||||||
| FaxNumber: | 4794525047 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 FORT ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BARLING | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729232164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794945700 | ||||||||
| FaxNumber: | 4794786213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2016 | ||||||||
| LastUpdateDate: | 05/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.