1700074747 NPI number — METRO ENT, P.A.

Table of content: MRS. SAMANTHA ELIZABETH MORALES LCSW (NPI 1346762796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700074747 NPI number — METRO ENT, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO ENT, P.A.
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:
1700074747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 N GALLOWAY AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MESQUITE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-404-6409
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 N GALLOWAY AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-404-6409
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SUBRAMANIAN
Authorized Official First Name:
GEETHA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
214-404-6409

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  M7666 , 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: 193137001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19QW . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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