1487866752 NPI number — MATTHEW D MORRIS MD

Table of content: MATTHEW D MORRIS MD (NPI 1487866752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487866752 NPI number — MATTHEW D MORRIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRIS
Provider First Name:
MATTHEW
Provider Middle Name:
D
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:
1487866752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 E CHESTNUT ST BLDG SUITE303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-1831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-629-5552
Provider Business Mailing Address Fax Number:
502-629-3132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 S FLOYD ST
Provider Second Line Business Practice Location Address:
# 14
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-629-5552
Provider Business Practice Location Address Fax Number:
502-629-3132
Provider Enumeration Date:
05/07/2007

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:  42698 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3119642 . This is a "NIC/CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00754429 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200958580 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100075560 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000023036Z . This is a "NIS/HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50024999 . This is a "NIS/PHP" identifier . This identifiers is of the category "OTHER".




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