Provider Demographics
NPI:1780835355
Name:THE MORGAN FAMILY CLINIC
Entity Type:Organization
Organization Name:THE MORGAN FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:DIANN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:662-390-8992
Mailing Address - Street 1:PO BOX 4577
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-4577
Mailing Address - Country:US
Mailing Address - Phone:662-332-8848
Mailing Address - Fax:662-332-8854
Practice Address - Street 1:1699 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7211
Practice Address - Country:US
Practice Address - Phone:662-390-8992
Practice Address - Fax:662-335-7933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117241Medicaid
MS00117241Medicaid
MS512I500529Medicare PIN