Provider Demographics
NPI:1821101296
Name:ROBERT MORRIS ENTERPRISES LLC
Entity Type:Organization
Organization Name:ROBERT MORRIS ENTERPRISES LLC
Other - Org Name:ROBERT K. MORRIS, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-897-9045
Mailing Address - Street 1:PO BOX 773
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-0773
Mailing Address - Country:US
Mailing Address - Phone:419-897-9045
Mailing Address - Fax:419-893-3320
Practice Address - Street 1:5757 MONCLOVA RD
Practice Address - Street 2:SUITE 17
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1863
Practice Address - Country:US
Practice Address - Phone:419-897-9045
Practice Address - Fax:419-893-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055343208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF1943OtherRAILROAD MEDICARE
OH2874868Medicaid
DF1943OtherRAILROAD MEDICARE