Provider Demographics
NPI:1831124478
Name:KATHLEEN A ROGERS
Entity Type:Organization
Organization Name:KATHLEEN A ROGERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:417-350-8100
Mailing Address - Street 1:2224 NW 50TH ST
Mailing Address - Street 2:STE. 276W
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8046
Mailing Address - Country:US
Mailing Address - Phone:405-858-2350
Mailing Address - Fax:
Practice Address - Street 1:5273 S AARON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2879
Practice Address - Country:US
Practice Address - Phone:417-350-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO27998247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000047064Medicare ID - Type Unspecified