Noble U. Ezukanma, M.D.
Individual provider Active NPI Pulmonary Disease Physician · Lakeside, TX
NPI 1295705291 · NPPES record last updated Jul 23, 2012
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Jan 18, 2018.
Key facts
- NPI
- 1295705291
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pulmonary Disease Physician 207RP1001X
- License
- K8745 (TX)
- Practice address
- 8401 Jacksboro Hwy
Suite 218
Lakeside, TX 76135-4351 - Phone
- (817) 338-0400
- Fax
- (817) 338-0401
- NPI assigned
- Jan 24, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| K8745 | TX | MD | Pulmonary Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Texas Health Care, P.L.L.C. | Internal Medicine | Past | Accepting new patients |
| Alpha Pulmonary Critical Care Consultants, PLLC | Pulmonary Disease | Past | Accepting new patients |
| Alpha Pulmonary Critical Care Consultants, PLLC | Pulmonary Disease | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | K8745 | TX | |
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | K8745 | TX | |
| Pulmonary Disease Physician | 207RP1001X | K8745 | TX | Yes |
Addresses
Primary practice location
8401 Jacksboro Hwy
Suite 218
Lakeside, TX 76135-4351
Mailing address
508 S Adams St
Suite 218
Fort Worth, TX 76104-2147
Phone (817) 338-0400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 044684101 | Medicaid | TX |
Other providers in Lakeside, TX
- Mariella E Clark
- Kathi Edmonson
- Kimberli Paige Edmonson
- Mainstream Habilitation Services of Texas, Inc.
- Chase C McKinney
- Pathfinder Counseling and Consulting
- Sage Substance Abuse Guidance and Education
- Kelle Creecy White
All providers in Lakeside, TX · Pulmonary Disease Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- OIG LEIE (HHS Office of Inspector General).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.