Provider Demographics
NPI:1396105136
Name:ROGERS HEARING HEALTHCARE, INC
Entity type:Organization
Organization Name:ROGERS HEARING HEALTHCARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-A, FAAA
Authorized Official - Phone:601-261-5995
Mailing Address - Street 1:PO BOX 17167
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-7167
Mailing Address - Country:US
Mailing Address - Phone:601-261-5995
Mailing Address - Fax:601-261-5335
Practice Address - Street 1:3901 HARDY ST STE 100
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1696
Practice Address - Country:US
Practice Address - Phone:601-261-5995
Practice Address - Fax:601-261-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1021A261QH0700X
LA4535261QH0700X
MSA3163261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512I640023OtherMEDICARE PTAN
MS04979391Medicaid