Provider Demographics
NPI:1306421896
Name:MARION COUNTY CHILDREN'S ADVOCACY CENTER, INC.
Entity type:Organization
Organization Name:MARION COUNTY CHILDREN'S ADVOCACY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD-MPH
Authorized Official - Phone:352-873-4739
Mailing Address - Street 1:2800 NE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-4820
Mailing Address - Country:US
Mailing Address - Phone:352-873-4739
Mailing Address - Fax:352-873-6795
Practice Address - Street 1:2800 NE 14TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-4820
Practice Address - Country:US
Practice Address - Phone:352-873-4739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse PediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0071304OtherLICENSE NUMBER