Provider Demographics
NPI:1679548242
Name:MORTON, RICHARD FRANKLIN (CRNA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:FRANKLIN
Last Name:MORTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711841
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-0001
Mailing Address - Country:US
Mailing Address - Phone:304-346-9400
Mailing Address - Fax:
Practice Address - Street 1:1200 J D ANDERSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3494
Practice Address - Country:US
Practice Address - Phone:304-285-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN332197L367500000X
WV71673367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1072625OtherBRICKSTREET
WV3810004048Medicaid
WV001706469OtherMSBCBS
WV002012792OtherMSBCBS
WV0207026000Medicaid
WV27005299701OtherBRICKSTREET GROUP
OH2832902Medicaid
WV270052997OtherTRICARE
WV9333201Medicare PIN
WV270052997OtherTRICARE
OH2832902Medicaid