1548358427 NPI number — DR. MARIO R MORENAS MD

Table of content: DR. MARIO R MORENAS MD (NPI 1548358427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548358427 NPI number — DR. MARIO R MORENAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORENAS
Provider First Name:
MARIO
Provider Middle Name:
R
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:
1548358427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3456
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARTLESVILLE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74006-3456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-333-3830
Provider Business Mailing Address Fax Number:
918-333-3846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 E FRANK PHILLIPS BLVD
Provider Second Line Business Practice Location Address:
JPMC ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
BARTLESVILLE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74006-2411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-331-1555
Provider Business Practice Location Address Fax Number:
918-331-1695
Provider Enumeration Date:
10/10/2006

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: 207L00000X , with the licence number:  21669 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X , with the licence number: 21669 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100032890A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100371240A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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