Provider Demographics
NPI:1245519578
Name:ROGERS, SASHA (BHRS)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 SW 114TH
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170
Mailing Address - Country:US
Mailing Address - Phone:405-919-7796
Mailing Address - Fax:
Practice Address - Street 1:4149 HIGHLINE BLVD
Practice Address - Street 2:380
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108
Practice Address - Country:US
Practice Address - Phone:405-949-1000
Practice Address - Fax:405-949-1063
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049040Medicaid