Provider Demographics
NPI:1669074514
Name:ROGUE PROSTHETICS, LLC
Entity type:Organization
Organization Name:ROGUE PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:HATT
Authorized Official - Suffix:
Authorized Official - Credentials:LPO, MHI
Authorized Official - Phone:936-225-3339
Mailing Address - Street 1:1821 W FRANK AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3105
Mailing Address - Country:US
Mailing Address - Phone:936-225-3339
Mailing Address - Fax:936-571-0599
Practice Address - Street 1:1821 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3105
Practice Address - Country:US
Practice Address - Phone:936-225-3339
Practice Address - Fax:936-571-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-14
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty