1811996325 NPI number — JOHN W MORTON O.D.,P.S.C.

Table of content: JOHN W MORTON O.D.,P.S.C. (NPI 1811996325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811996325 NPI number — JOHN W MORTON O.D.,P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORTON
Provider First Name:
JOHN
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.,P.S.C.
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:
1811996325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 13TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41101-2607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-329-1404
Provider Business Mailing Address Fax Number:
606-325-7446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-329-1404
Provider Business Practice Location Address Fax Number:
606-325-7446
Provider Enumeration Date:
07/18/2005

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: 152W00000X , with the licence number:  803DT , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1418243 . This is a "UNITED MINE WORKERS ASSOC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5315095 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: K115 . This is a "BC BS OF KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000047400 . This is a "ANTHEM BLUE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 410003978 . This is a "PALMETTO RAILROAD MEDICAR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 77008035 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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