Provider Demographics
NPI:1932134194
Name:HEGER, RODRICK
Entity Type:Individual
Prefix:
First Name:RODRICK
Middle Name:
Last Name:HEGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:HUGOTON
Mailing Address - State:KS
Mailing Address - Zip Code:67951
Mailing Address - Country:US
Mailing Address - Phone:620-544-2827
Mailing Address - Fax:
Practice Address - Street 1:1006 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGOTON
Practice Address - State:KS
Practice Address - Zip Code:67951-2842
Practice Address - Country:US
Practice Address - Phone:620-544-8563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0529888207Q00000X
KS05-29888207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000104590OtherBCBS
KS100428240AMedicaid
KS0000104590OtherBCBS