1447299706 NPI number — DR. LINDA JEAN MORGAN MD

Table of content: ALEXANDRA TAN MD (NPI 1144012667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447299706 NPI number — DR. LINDA JEAN MORGAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORGAN
Provider First Name:
LINDA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORGAN-EVANS
Provider Other First Name:
LINDA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447299706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
881 OLD ROUTE 66 BLDG 3C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST ROBERTS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65584-3732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-420-7900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
881 OLD ROUTE 66, 3C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST ROBERTS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65584-3732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-336-3644
Provider Business Practice Location Address Fax Number:
888-831-8225
Provider Enumeration Date:
06/05/2006

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: 207Q00000X , with the licence number:  111945 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 207571506 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".