ROGUE MEDICAL LLC NPI 1265298400

NPI Information

NPI: 1265298400
Provider Name: ROGUE MEDICAL LLC
Classification: Physician Assistant - 363AM0700X
Entity Type: Organization

Specialization: Medical

CLIA Number: 38D2231045

Address:
205 N PHOENIX RD STE 430
PHOENIX, OR
ZIP 97535
Phone: (541) 778-4517
Get Directions

ROGUE MEDICAL LLC is a medical physician assistant in Phoenix, OR. ROGUE MEDICAL LLC NPI is 1265298400. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

205 N PHOENIX RD STE 430
PHOENIX, OR
ZIP 97535-108
Phone: (541) 778-4517
Fax: (541) 833-0995

The provider's authorized official is Ben Douglas Johnson .
The authorized official title is Owner and has the following contact phone number (541) 778-4517.

The CLIA number assigned to this NPI record is 38D2231045 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/26/2024 and was last updated on 2/26/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical			No
2	363AM0700X	Physician Assistant	Medical			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »