Provider Demographics
NPI:1679613004
Name:ROGERS, EILEEN MARIE (PAC)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:MARIE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1053 CENTER STREET
Mailing Address - Street 2:SC HOUSE CALLS INC.
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:
Practice Address - Street 1:1053 CENTER STREET
Practice Address - Street 2:SC HOUSE CALLS INC.
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC781363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0305PAMedicaid
SCSC71278798Medicare PIN
SCSC71275281Medicare PIN
SC0305PAMedicaid