Provider Demographics
NPI:1275203820
Name:CHARLIE ANN MOREHEAD, MD, LLC
Entity Type:Organization
Organization Name:CHARLIE ANN MOREHEAD, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOREHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-255-4522
Mailing Address - Street 1:132 BUCKS LN
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-5722
Mailing Address - Country:US
Mailing Address - Phone:979-255-4522
Mailing Address - Fax:
Practice Address - Street 1:1815 10TH ST
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-2765
Practice Address - Country:US
Practice Address - Phone:979-255-4522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty