1316012107 NPI number — ARCHIBALD R MORRIS OD

Table of content: (NPI 1316012107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316012107 NPI number — ARCHIBALD R MORRIS OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARCHIBALD R MORRIS OD
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:
1316012107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 MANOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EBENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15931-2081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-472-9670
Provider Business Mailing Address Fax Number:
814-472-9704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 MANOR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EBENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15931-2081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-472-9670
Provider Business Practice Location Address Fax Number:
814-472-9704
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
ARCHIBALD
Authorized Official Middle Name:
REGIS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
814-472-9670

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000628 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0009711820002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 391971 . This is a "NVA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50704 . This is a "DAVIS VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA06285 . This is a "VBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 506722 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 208734 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5153452 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DG2847 . This is a "PALMETTO GBA RAILROADERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: AM15624 . This is a "SPECTERA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1361126 . This is a "FUNDS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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