1356770184 NPI number — TARA C. MORSE, LLC

Table of content: (NPI 1356770184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356770184 NPI number — TARA C. MORSE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TARA C. MORSE, LLC
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:
1356770184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W74N522 WEBSTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDARBURG
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53012-1816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-615-6243
Provider Business Mailing Address Fax Number:
215-249-6206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6301 FORBES AVE STE 235
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15217-1725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-615-6243
Provider Business Practice Location Address Fax Number:
215-249-6206
Provider Enumeration Date:
11/02/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORSE
Authorized Official First Name:
TARA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
612-615-6243

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CW017335 , 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)