Provider Demographics
NPI:1861662777
Name:EDWIN J MORRIS,DO RHC
Entity Type:Organization
Organization Name:EDWIN J MORRIS,DO RHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-986-1750
Mailing Address - Street 1:118 MARKET ST
Mailing Address - Street 2:PO BOX 111
Mailing Address - City:MANNINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26582-1131
Mailing Address - Country:US
Mailing Address - Phone:304-986-1750
Mailing Address - Fax:304-986-3742
Practice Address - Street 1:118 MARKET ST
Practice Address - Street 2:
Practice Address - City:MANNINGTON
Practice Address - State:WV
Practice Address - Zip Code:26582-1131
Practice Address - Country:US
Practice Address - Phone:304-986-1750
Practice Address - Fax:304-986-3742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0034731000Medicaid
WV513879Medicare UPIN
WV513879Medicare Oscar/Certification
WV0578413Medicare PIN