1962460766 NPI number — MORRIS SALES HOSPITAL SHOPPE, INC.

Table of content: (NPI 1962460766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962460766 NPI number — MORRIS SALES HOSPITAL SHOPPE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRIS SALES HOSPITAL SHOPPE, 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:
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:
1962460766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4015 E 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26104-3869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-424-6363
Provider Business Mailing Address Fax Number:
304-422-7396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4015 E 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26104-3869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-424-6363
Provider Business Practice Location Address Fax Number:
304-422-7396
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
304-424-6363

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0220540 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0147983000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001705416 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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