Provider Demographics
NPI:1518023274
Name:KENNETH WAYNE MORRIS
Entity Type:Organization
Organization Name:KENNETH WAYNE MORRIS
Other - Org Name:PHYSIOLOGICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-237-8429
Mailing Address - Street 1:PO BOX 136372
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76136-0372
Mailing Address - Country:US
Mailing Address - Phone:817-237-8429
Mailing Address - Fax:817-237-8583
Practice Address - Street 1:4707 ALWOOD CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-1901
Practice Address - Country:US
Practice Address - Phone:817-237-8429
Practice Address - Fax:817-237-8583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ0PL03320Medicaid
TXX28409Medicare UPIN
TXFTCP02Medicare ID - Type UnspecifiedIDTF