Provider Demographics
NPI:1740543685
Name:ROGERSVILLE PEDIATRICS,LLC
Entity type:Organization
Organization Name:ROGERSVILLE PEDIATRICS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP/ OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-386-4151
Mailing Address - Street 1:1120 S JACKSON HWY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-5777
Mailing Address - Country:US
Mailing Address - Phone:256-386-4151
Mailing Address - Fax:
Practice Address - Street 1:16023 HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35652-8141
Practice Address - Country:US
Practice Address - Phone:256-386-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty