Provider Demographics
NPI:1528347127
Name:NNAEMEKA MORAH
Entity type:Organization
Organization Name:NNAEMEKA MORAH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNERE/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NNAEMEKA
Authorized Official - Middle Name:RUFUS
Authorized Official - Last Name:MORAH
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R),(CT)
Authorized Official - Phone:9782-266-4366
Mailing Address - Street 1:5093 NORIC DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2575
Mailing Address - Country:US
Mailing Address - Phone:972-266-4366
Mailing Address - Fax:
Practice Address - Street 1:5093 NORIC DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2575
Practice Address - Country:US
Practice Address - Phone:972-266-4366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28210335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier