Provider Demographics
NPI:1922016575
Name:MORRIS MCKELLAR AND CARTER MOORE
Entity Type:Organization
Organization Name:MORRIS MCKELLAR AND CARTER MOORE
Other - Org Name:OB ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-572-5882
Mailing Address - Street 1:304 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2328
Mailing Address - Country:US
Mailing Address - Phone:903-572-5882
Mailing Address - Fax:903-572-7330
Practice Address - Street 1:304 W 20TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2328
Practice Address - Country:US
Practice Address - Phone:903-572-5882
Practice Address - Fax:903-572-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6448 AND E8708207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0841405-01Medicaid