Provider Demographics
NPI:1376621540
Name:JOHN DAVID ROGERS
Entity Type:Organization
Organization Name:JOHN DAVID ROGERS
Other - Org Name:KINETIC HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-926-0870
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-0638
Mailing Address - Country:US
Mailing Address - Phone:304-926-0870
Mailing Address - Fax:
Practice Address - Street 1:2200 GRAND CENTRAL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-1300
Practice Address - Country:US
Practice Address - Phone:304-295-6041
Practice Address - Fax:304-295-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001815473OtherBLUE CROSS BLUE SHIELD
OH2027096Medicaid
WV0147774001Medicaid
WV1164210003Medicare NSC
WV1164210003Medicare ID - Type UnspecifiedMEDICARE