Provider Demographics
NPI:1407018054
Name:MORTON PLANT HEALTH SERVICES
Entity Type:Organization
Organization Name:MORTON PLANT HEALTH SERVICES
Other - Org Name:WOMENS IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COURIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-843-4500
Mailing Address - Street 1:PO BOX 404841
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4841
Mailing Address - Country:US
Mailing Address - Phone:813-852-3272
Mailing Address - Fax:813-852-3233
Practice Address - Street 1:27001 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 8280
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3402
Practice Address - Country:US
Practice Address - Phone:727-796-2056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0636592-07Medicaid
FL00594Medicare PIN