Basic Information
| Provider Information | |||||||||
| NPI: | 1861662777 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDWIN J MORRIS,DO RHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 MARKET ST | ||||||||
| Address2: | PO BOX 111 | ||||||||
| City: | MANNINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265821131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3049861750 | ||||||||
| FaxNumber: | 3049863742 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | MANNINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265821131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3049861750 | ||||||||
| FaxNumber: | 3049863742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2008 | ||||||||
| LastUpdateDate: | 03/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | MORRIS | ||||||||
| AuthorizedOfficialFirstName: | EDWIN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3049861750 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 925 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0034731000 | 05 | WV | MEDICAID |