1265815625 NPI number — MR. STEPHEN RICHARD MORGANO LISW

Table of content: MR. STEPHEN RICHARD MORGANO LISW (NPI 1265815625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265815625 NPI number — MR. STEPHEN RICHARD MORGANO LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORGANO
Provider First Name:
STEPHEN
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LISW
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:
1265815625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 BOATNER RD STE 114
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EGLIN AFB
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32542-1302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-883-8600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51ST MEDICAL GROUP
Provider Second Line Business Practice Location Address:
UNIT 2060
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96278-2060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-784-2148
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2015

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: 1041C0700X , with the licence number:  I.1700747 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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