1477517175 NPI number — ANGELO P MORREALE, DPM, A PROF CORP

Table of content: (NPI 1477517175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477517175 NPI number — ANGELO P MORREALE, DPM, A PROF CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELO P MORREALE, DPM, A PROF CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE FOOT INSTITUTE
Provider Other Organization Name Type Code:
3
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:
1477517175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2817
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NATCHITOCHES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71457-0817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-357-9559
Provider Business Mailing Address Fax Number:
318-357-1263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 DIXIE PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATCHITOCHES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71457-5881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-357-9559
Provider Business Practice Location Address Fax Number:
318-357-1263
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORREALE
Authorized Official First Name:
ANGELO
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
318-357-9559

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ER0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0131X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: C6593 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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