1710393186 NPI number — MORRIS MEDICAL GROUP OF LEXINGTON

Table of content: (NPI 1710393186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710393186 NPI number — MORRIS MEDICAL GROUP OF LEXINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRIS MEDICAL GROUP OF LEXINGTON
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:
1710393186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1941 BISHOP LN
Provider Second Line Business Mailing Address:
#508
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40218-1922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-451-0484
Provider Business Mailing Address Fax Number:
502-451-0778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3292 EAGLE VIEW LN
Provider Second Line Business Practice Location Address:
#310
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-2173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-309-1908
Provider Business Practice Location Address Fax Number:
859-201-1400
Provider Enumeration Date:
07/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
WALTER
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
817-739-7641

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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