1649352741 NPI number — DR. MARTHA R MORROW O.D.

Table of content: DR. MARTHA R MORROW O.D. (NPI 1649352741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649352741 NPI number — DR. MARTHA R MORROW O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORROW
Provider First Name:
MARTHA
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

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:
1649352741
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1177
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELLVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35653-1177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-332-5440
Provider Business Mailing Address Fax Number:
256-332-5402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15255 HIGHWAY 43
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
RUSSELLVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35653-1924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-332-5440
Provider Business Practice Location Address Fax Number:
256-332-5402
Provider Enumeration Date:
10/19/2006

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: 152W00000X , with the licence number:  S339TA144 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 410031311 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051059364 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051527545 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 0550110002 . This is a "PALMETTO" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051527544 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000059364 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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