Provider Demographics
NPI:1033095617
Name:RODGERS MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:RODGERS MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-613-7835
Mailing Address - Street 1:13418 ATTALA ROAD 4101
Mailing Address - Street 2:
Mailing Address - City:SALLIS
Mailing Address - State:MS
Mailing Address - Zip Code:39160-5242
Mailing Address - Country:US
Mailing Address - Phone:601-613-7835
Mailing Address - Fax:
Practice Address - Street 1:630 NORTHWEST AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:MS
Practice Address - Zip Code:39063-3337
Practice Address - Country:US
Practice Address - Phone:662-653-3011
Practice Address - Fax:662-653-6423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care