Provider Demographics
NPI:1295231066
Name:MORGAN, JEDIDIAH
Entity Type:Individual
Prefix:
First Name:JEDIDIAH
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 MCLOUGHLIN DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-9447
Mailing Address - Country:US
Mailing Address - Phone:888-526-9353
Mailing Address - Fax:
Practice Address - Street 1:6350 MCLOUGHLIN DR
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-9447
Practice Address - Country:US
Practice Address - Phone:888-526-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$Medicaid