1558310839 NPI number — JAMES W FERGUSON MD

Table of content: JAMES W FERGUSON MD (NPI 1558310839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558310839 NPI number — JAMES W FERGUSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERGUSON
Provider First Name:
JAMES
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1558310839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 938
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILLEEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76540-0938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-634-6999
Provider Business Mailing Address Fax Number:
254-200-4090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 LONDONDERRY DR
Provider Second Line Business Practice Location Address:
300
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76712-7924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-772-2722
Provider Business Practice Location Address Fax Number:
254-772-4075
Provider Enumeration Date:
05/06/2006

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: 208000000X , with the licence number:  E4327 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20356263 . This is a "BEECHSTREET" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00FZ09 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 525245 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 742330906001 . This is a "HUMANA/MILITARY-TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 112616100 . This is a "FIRSTCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 9486752001 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 091801301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 091801302 . This is a "MEDICAID EPSDT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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