Provider Demographics
NPI:1346411840
Name:GLORI E. FERGUSON
Entity Type:Organization
Organization Name:GLORI E. FERGUSON
Other - Org Name:MEDICAL HOUSE CALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORI
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-272-3215
Mailing Address - Street 1:1427 IDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-3427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1427 IDLEWOOD LN
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-3427
Practice Address - Country:US
Practice Address - Phone:432-272-3215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX632473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1629059852OtherINDIVIDUAL NPI
8C8266OtherPROVIDER #
TX00631XOtherMEDICARE GROUP #
8C8266OtherPROVIDER #