1295767515 NPI number — H MICHAEL OGBURN MD

Table of content: H MICHAEL OGBURN MD (NPI 1295767515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295767515 NPI number — H MICHAEL OGBURN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGBURN
Provider First Name:
H
Provider Middle Name:
MICHAEL
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:
1295767515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 THIS WAY ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE JACKSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77566-5152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-297-2220
Provider Business Mailing Address Fax Number:
979-297-3330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7777 SOUTHWEST FREEWAY
Provider Second Line Business Practice Location Address:
SUITE 1052
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-988-8776
Provider Business Practice Location Address Fax Number:
713-988-8662
Provider Enumeration Date:
07/07/2006

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: 207RN0300X , with the licence number:  F3572 , 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: 00HK40 . This is a "BCBS#" identifier . This identifiers is of the category "OTHER".
  • Identifier: P01090518 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 123311601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123311609 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 390001408 . This is a "RARILROAD GBA#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123311604 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 390002501 . This is a "RAILROAD GBA #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 82C329 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8DE542 . This is a "BC/BS #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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