1902925001 NPI number — FREDDIE M MORALES MD PULMONARY DISEASES & INTERNAL MEDICINE CLINIC

Table of content: (NPI 1902925001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902925001 NPI number — FREDDIE M MORALES MD PULMONARY DISEASES & INTERNAL MEDICINE CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREDDIE M MORALES MD PULMONARY DISEASES & INTERNAL MEDICINE CLINIC
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:
FREDDIE M. MORALES M.D.
Provider Other Organization Name Type Code:
4
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:
1902925001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2207 CLEAR CREEK RD STE 302
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:
76549-4345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-554-3003
Provider Business Mailing Address Fax Number:
254-554-8362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2207 CLEAR CREEK RD STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILLEEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76549-4345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-554-3003
Provider Business Practice Location Address Fax Number:
254-554-8362
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORALES
Authorized Official First Name:
FREDDIE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
254-554-3003

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RS0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: G6081 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 174691901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90055463 . This is a "DPS REGISTRATION #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DB7452 . This is a "RAILROAD GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0014GN . This is a "BLUE CROSS GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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