Provider Demographics
NPI:1427180520
Name:STOCKTON CARDIO THORACIC SURG MD G
Entity Type:Organization
Organization Name:STOCKTON CARDIO THORACIC SURG MD G
Other - Org Name:JAMES D MORRISSEY, M.D., INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-948-1236
Mailing Address - Street 1:1617 N CALIFORNIA ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6117
Mailing Address - Country:US
Mailing Address - Phone:209-948-1234
Mailing Address - Fax:209-462-9233
Practice Address - Street 1:1617 N CALIFORNIA ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6117
Practice Address - Country:US
Practice Address - Phone:209-948-1234
Practice Address - Fax:209-462-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG230972086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR00053080Medicaid
CAZZZ82333ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID