1043853955 NPI number — MRS. RUTH MORRIS CHURCH NURSE PRACTITIONER

Table of content: DR. OMAR KRAD M.D. (NPI 1669635132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043853955 NPI number — MRS. RUTH MORRIS CHURCH NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHURCH
Provider First Name:
RUTH
Provider Middle Name:
MORRIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHURCH
Provider Other First Name:
RUTH
Provider Other Middle Name:
MORRIS
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RUTH MORRIS, BSN, RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043853955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27731 EASTLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARVEST
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35749-7549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-777-6746
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8216 MADISON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35758-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-464-9991
Provider Business Practice Location Address Fax Number:
256-464-9994
Provider Enumeration Date:
10/23/2019

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: 363LA2200X , with the licence number:  1-054980 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com