1013038447 NPI number — MORGAN AND MORIO ORAL AND MAXILLOFACIAL SURGERY

Table of content: (NPI 1013038447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013038447 NPI number — MORGAN AND MORIO ORAL AND MAXILLOFACIAL SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORGAN AND MORIO ORAL AND MAXILLOFACIAL SURGERY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1013038447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1395 BOYSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIAWATHA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52233-2210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-743-0077
Provider Business Mailing Address Fax Number:
319-743-0102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1395 BOYSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIAWATHA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52233-2210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-743-0077
Provider Business Practice Location Address Fax Number:
319-743-0102
Provider Enumeration Date:
04/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORIO
Authorized Official First Name:
DOMINIC
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
319-743-0077

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  08382 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X , with the licence number: 08116 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0492462 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2468819 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".