Rodgers Medical Clinic
Organization Active NPI Primary Care Clinic/Center · Durant, MS
NPI 1033095617 · NPPES record last updated Sep 5, 2025
Key facts
- NPI
- 1033095617
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- RODGERS MEDICAL CLINIC
- Practice address
- 630 Northwest Ave
Durant, MS 39063-3337 - Phone
- (662) 653-3011
- Fax
- (662) 653-6423
- NPI assigned
- Aug 12, 2025
- Organization subpart
- No
Authorized official
- Name
- Phillip Eric Rodgers, NP
- Title
- Nurse Practitioner
- Phone
- (601) 613-7835
Practitioners 3
-
Phillip Eric Rodgers, FNP-C
-
Michael T Beckum, FNP
-
Wirt Fletcher Shrock Jr., M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2333232 | Rodgers Medical Clinic | Provider-performed microscopy | Oct 30, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20251027002278 | MS | Part B Supplier - Clinic/Group Practice | 3072002534 |
Receives reassigned benefits from 1 practitioner Practice locations: Durant, MS |
National Provider Directory
Locations
630 Northwest Ave
Durant, MS 39063
Phone (662) 653-3011
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
630 Northwest Ave
Durant, MS 39063-3337
Mailing address
13418 Attala Road 4101
Sallis, MS 39160-5242
Phone (601) 613-7835
Other names
- Rodgers Medical Clinic
Other providers in Durant, MS
- Peace Wellness Center, LLC
- Peace Wellness Mobile Unit
- Tiffany Denice Redd
- Bonita T Roby
- Daryl Roby
- Phillip Eric Rodgers
- S&M Medical Clinic
- Shannon Pritchard
- Wirt Fletcher Shrock Jr.
- Marilyn Smith
All providers in Durant, MS · Primary Care Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.