1255326906 NPI number — DR. JOHN EDWARD MORAGNE MD

Table of content: DR. JOHN EDWARD MORAGNE MD (NPI 1255326906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255326906 NPI number — DR. JOHN EDWARD MORAGNE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORAGNE
Provider First Name:
JOHN
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
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:
1255326906
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3945
Provider Second Line Business Mailing Address:
DEPT 792
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77253-3945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-358-8114
Provider Business Mailing Address Fax Number:
281-358-0609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4120 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77027-7339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-355-8600
Provider Business Practice Location Address Fax Number:
713-355-8069
Provider Enumeration Date:
09/19/2005

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: 207L00000X , with the licence number:  J1319 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X , with the licence number: J1319 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: R0081099 . This is a "DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 050068169 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 115178902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1501409 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 85300N . This is a "BLUE CROSS/BLUE SHEILD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 115178904 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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