Basic Information
Provider Information | |||||||||
NPI: | 1013964493 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MORGAN | ||||||||
FirstName: | CHAD | ||||||||
MiddleName: | J | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 9434 | ||||||||
Address2: |   | ||||||||
City: | SPRINGFIELD | ||||||||
State: | MO | ||||||||
PostalCode: | 658019434 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4178853888 | ||||||||
FaxNumber: | 4178817638 | ||||||||
Practice Location | |||||||||
Address1: | 3801 S NATIONAL AVE | ||||||||
Address2: | WEST TOWER, SUITE 700 | ||||||||
City: | SPRINGFIELD | ||||||||
State: | MO | ||||||||
PostalCode: | 658075210 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4178853888 | ||||||||
FaxNumber: | 4178817638 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/30/2006 | ||||||||
LastUpdateDate: | 09/30/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/30/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | E-4936 | AR | N |   | Allopathic & Osteopathic Physicians | Neurological Surgery |   | 207T00000X | 2006005747 | MO | Y |   | Allopathic & Osteopathic Physicians | Neurological Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 2561113 | 01 | MO | COX HEALTH PLANS UPI | OTHER | 5H031 | 01 | AR | ARKANSAS BC/BS | OTHER | 209237 | 01 | MO | BLUE CROSS / CHOICE | OTHER | 0600288 | 01 | MO | UNITED HEALTHCARE | OTHER | 4188130001 | 01 | MO | CIGNA MEDICARE | OTHER | 5H031 | 01 | AR | ARKANSAS HEALTH ADVANTAGE | OTHER | 0215051 | 01 | WA | DEPARTMENT OF LABOR WA | OTHER | 6874728001 | 01 | MO | CIGNA HEALTHCARE | OTHER | 776447 | 01 | MO | HEALTHLINK | OTHER | 166615001 | 05 | AR |   | MEDICAID | 201503307 | 05 | MO |   | MEDICAID | 5H031 | 01 | AR | ARKANSAS FIRST SOURCE | OTHER |