Provider Demographics
NPI:1437412210
Name:OGDEN-MCKEE, SUSAN M (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:OGDEN-MCKEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3745
Mailing Address - Country:US
Mailing Address - Phone:940-627-7440
Mailing Address - Fax:940-627-7464
Practice Address - Street 1:1001 W EAGLE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3745
Practice Address - Country:US
Practice Address - Phone:940-627-7440
Practice Address - Fax:940-627-7464
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07911207Q00000X
TX123512471C1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C1101XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiovascular-Interventional Technology
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA07911OtherMEDICAL LICENSE
TXPA07911OtherMEDICAL LICENSE