1063689651 NPI number — DR. ROBERTO ANTONIO MORAN-BOJORQUEZ M.D.

Table of content: DR. ROBERTO ANTONIO MORAN-BOJORQUEZ M.D. (NPI 1063689651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063689651 NPI number — DR. ROBERTO ANTONIO MORAN-BOJORQUEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORAN-BOJORQUEZ
Provider First Name:
ROBERTO
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063689651
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MERCY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64804-4524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-556-2300
Provider Business Mailing Address Fax Number:
417-556-3625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MERCY WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-4524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-556-2300
Provider Business Practice Location Address Fax Number:
417-556-3625
Provider Enumeration Date:
05/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  2009016964 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 2009016964 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 180149001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00800421 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 200616820B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200258970A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063689651 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com