Provider Demographics
NPI:1417145889
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:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
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:304-363-7424
Mailing Address - Fax:
Practice Address - Street 1:1014 HONEYBEE DRIVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-363-7424
Practice Address - Fax:304-363-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2803907Medicaid
KY7100027700Medicaid
WV3810010234Medicaid
OH2803907Medicaid