1669413886 NPI number — DR. WAYNE L MORTON MD

Table of content: DR. WAYNE L MORTON MD (NPI 1669413886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669413886 NPI number — DR. WAYNE L MORTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORTON
Provider First Name:
WAYNE
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669413886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 570
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSCEOLA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64776-0570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-646-8123
Provider Business Mailing Address Fax Number:
417-646-8911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 GIESLER DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSCEOLA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64776-6297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-646-8123
Provider Business Practice Location Address Fax Number:
417-646-8911
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  R6098 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332900000X , with the licence number: R6098 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 600578918 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200578920 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33471 . This is a "HEALTHCARE USA MC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 04840042 . This is a "BLUE CROSS BLUE SHIELD KC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 328760 . This is a "FAMILY HEALTH PARTNERS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 129236 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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