Provider Demographics
NPI:1518232230
Name:MELISSA MORGAN MD PC
Entity Type:Organization
Organization Name:MELISSA MORGAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-459-7546
Mailing Address - Street 1:1621 S EUCALYPTUS AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5940
Mailing Address - Country:US
Mailing Address - Phone:918-459-7546
Mailing Address - Fax:918-459-7575
Practice Address - Street 1:1621 S EUCALYPTUS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5940
Practice Address - Country:US
Practice Address - Phone:918-459-7546
Practice Address - Fax:918-459-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20128261Q00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK444522536MMedicare UPIN