1235139833 NPI number — JED LANE MORRIS MD

Table of content: JED LANE MORRIS MD (NPI 1235139833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235139833 NPI number — JED LANE MORRIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRIS
Provider First Name:
JED
Provider Middle Name:
LANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1235139833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4869
Provider Second Line Business Mailing Address:
DEPARTMENT 235
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77210-4869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-744-1141
Provider Business Mailing Address Fax Number:
847-537-4866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 NORTH BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-3743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-387-0851
Provider Business Practice Location Address Fax Number:
225-383-8477
Provider Enumeration Date:
07/26/2005

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: 207R00000X , with the licence number:  03455R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00143410 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1135780 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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