1356550123 NPI number — RANDY S. MORRIS, MD, SC

Table of content: (NPI 1356550123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356550123 NPI number — RANDY S. MORRIS, MD, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANDY S. MORRIS, MD, SC
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:
6
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:
1356550123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 N. WASHINGTON ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-357-6540
Provider Business Mailing Address Fax Number:
630-357-6435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 N. WASHINGTON ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-357-6540
Provider Business Practice Location Address Fax Number:
630-357-6435
Provider Enumeration Date:
05/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
630-357-6540

Provider Taxonomy Codes

  • Taxonomy code: 207VE0102X , with the licence number:  04261700 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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