Kenneth F Rodgers Md Pa | |
1707 Linwood Drive Suite A Paragould AR 72450 | |
(870) 236-2202 | |
(870) 236-8428 |
Full Name | Kenneth F Rodgers Md Pa |
---|---|
Speciality | Internal Medicine |
Location | 1707 Linwood Drive, Paragould, Arkansas |
Authorized Official Name and Position | Kenneth F Rodgers (OWNER) |
Authorized Official Contact | 8702362202 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Kenneth F Rodgers Md Pa 1707 Linwood Drive Suite A Paragould AR 72450 Ph: (870) 236-2202 | Kenneth F Rodgers Md Pa 1707 Linwood Drive Suite A Paragould AR 72450 Ph: (870) 236-2202 |
NPI Number | 1639351638 |
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Provider Enumeration Date | 11/30/2007 |
Last Update Date | 11/22/2016 |
Medicare PECOS PAC ID | 8224108493 |
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Medicare Enrollment ID | O20080529000939 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639351638 | NPI | - | NPPES |
209217702 | Other | MO | GTE DATA SERVICES MEDICAI |
118700001 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0100X | Internal Medicine - Gastroenterology | C7528 (Arkansas) | Primary |
Provider Name | Kenneth F Rodgers |
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Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1689633760 PECOS PAC ID: 4587558267 Enrollment ID: I20040212000349 |
Provider Name | Lacey Shayann Wyatt |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1649358847 PECOS PAC ID: 0244253995 Enrollment ID: I20060109000301 |
Provider Name | Lacey Jo Songer |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1609492420 PECOS PAC ID: 4385068329 Enrollment ID: I20200722004038 |
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