Provider Demographics
NPI:1710155577
Name:MORRIS F WISE MD PC
Entity Type:Organization
Organization Name:MORRIS F WISE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-333-7885
Mailing Address - Street 1:6724 TROOST AVE
Mailing Address - Street 2:608
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1526
Mailing Address - Country:US
Mailing Address - Phone:816-333-7885
Mailing Address - Fax:816-333-3507
Practice Address - Street 1:6724 TROOST AVE
Practice Address - Street 2:608
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1500
Practice Address - Country:US
Practice Address - Phone:816-333-7885
Practice Address - Fax:816-333-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOAW4297102261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0002059Medicare PIN
MOC50191Medicare UPIN