Provider Demographics
NPI:1174504518
Name:MORTON PLANT HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:MORTON PLANT HEALTH SERVICES, INC
Other - Org Name:CARLISLE IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COURIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-462-7746
Mailing Address - Street 1:P O BOX 404841
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0001
Mailing Address - Country:US
Mailing Address - Phone:813-852-3272
Mailing Address - Fax:813-852-3233
Practice Address - Street 1:1240 S FORT HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3308
Practice Address - Country:US
Practice Address - Phone:727-462-7514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0636592-01Medicaid