1821278425 NPI number — BRYCE A MORTON M D INC

Table of content: (NPI 1821278425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821278425 NPI number — BRYCE A MORTON M D INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRYCE A MORTON M D INC
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:
FALLBROOK HOSPITAL ANESTHESIA
Provider Other Organization Name Type Code:
3
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:
1821278425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1547
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEDALIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65302-1547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-826-5960
Provider Business Mailing Address Fax Number:
660-826-4852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
624 E ELDER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLBROOK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92028-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-728-1191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORTON
Authorized Official First Name:
BRYCE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
760-728-1191

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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