Provider Demographics
NPI:1629184379
Name:MORPHIS PEDIATRIC GROUP OF LANCASTER, P.A.
Entity Type:Organization
Organization Name:MORPHIS PEDIATRIC GROUP OF LANCASTER, P.A.
Other - Org Name:MORPHIS PEDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-416-5295
Mailing Address - Street 1:838 W MEETING ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-6233
Mailing Address - Country:US
Mailing Address - Phone:803-416-5295
Mailing Address - Fax:803-416-5240
Practice Address - Street 1:838 W MEETING ST
Practice Address - Street 2:SUITE A
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-6233
Practice Address - Country:US
Practice Address - Phone:803-416-5295
Practice Address - Fax:803-416-5240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRH096Medicaid