1891806295 NPI number — JESSICA A MORGAN M.D.

Table of content: JESSICA A MORGAN M.D. (NPI 1891806295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891806295 NPI number — JESSICA A MORGAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORGAN
Provider First Name:
JESSICA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERGAN
Provider Other First Name:
JESSICA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891806295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1524 NW KINGSTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97701-2134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-910-0380
Provider Business Mailing Address Fax Number:
541-278-8376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
929 SW SIMPSON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-389-7741
Provider Business Practice Location Address Fax Number:
541-278-8376
Provider Enumeration Date:
08/31/2006

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:  5071259-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 5071259-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 870526286 . This is a "HUMANA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870526286 . This is a "GREAT WEST" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870526286JES . This is a "EMIA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 73728 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: TPRA07821 . This is a "MOLINA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870526286 . This is a "FIRST HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 50112591201001 . This is a "BLUE CROSS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870526286 . This is a "PHCS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870526286 . This is a "CCN" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: P00008435 . This is a "RR MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 0101928 . This is a "UHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870526286 . This is a "MAILHANDLERS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: QM0000067482 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870526286 . This is a "BEECH STREET" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107011317102 . This is a "IHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 2122373 . This is a "CIGNA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 7306494 . This is a "AETNA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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