1487809067 NPI number — GLENN L. MORGAN M.D.,PA

Table of content: (NPI 1487809067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487809067 NPI number — GLENN L. MORGAN M.D.,PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLENN L. MORGAN M.D.,PA
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:
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:
1487809067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17070 RED OAK DR STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77090-2616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-444-0865
Provider Business Mailing Address Fax Number:
281-444-6037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17070 RED OAK DRIVE, STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-444-0865
Provider Business Practice Location Address Fax Number:
281-444-6037
Provider Enumeration Date:
11/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
GRACIE
Authorized Official Middle Name:
Authorized Official Title or Position:
LVN, INSURANCE PROCESSOR
Authorized Official Telephone Number:
281-444-0865

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  J0606 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0000X , with the licence number: J0606 , 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: 913214700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0096DN . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1381748 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160056100 . This is a "RAIL ROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 111898602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: B65629 . This is a "UPIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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