Provider Demographics
NPI:1144352998
Name:CITY OF ROGERS
Entity type:Organization
Organization Name:CITY OF ROGERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:VANATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-621-1179
Mailing Address - Street 1:201 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-6600
Mailing Address - Country:US
Mailing Address - Phone:479-621-1179
Mailing Address - Fax:479-621-1108
Practice Address - Street 1:201 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-6600
Practice Address - Country:US
Practice Address - Phone:479-621-1179
Practice Address - Fax:479-621-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1303416L0300X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101116715Medicaid
ARE1700Medicare UPIN
AR47093Medicare ID - Type Unspecified