Basic Information
| Provider Information | |||||||||
| NPI: | 1629370838 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORMAN W. MORRIS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PIONEER HEARING SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 COUNTRY CLUB RD | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013019792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137722922 | ||||||||
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| Practice Location | |||||||||
| Address1: | 329 CONWAY ST | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013011521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137735119 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2010 | ||||||||
| LastUpdateDate: | 11/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | MORRIS | ||||||||
| AuthorizedOfficialFirstName: | NORMAN | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/AUDIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 4137735119 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 697475 | 01 | MA | TUFTS | OTHER | 110086663A | 05 | MA | MEDICAID | AD0112 | 01 | MA | BCBS | OTHER | 110086899A | 05 | MA | MEDICAID |