Provider Demographics
NPI:1962460766
Name:MORRIS SALES HOSPITAL SHOPPE, INC.
Entity Type:Organization
Organization Name:MORRIS SALES HOSPITAL SHOPPE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:304-424-6363
Mailing Address - Street 1:4015 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-3869
Mailing Address - Country:US
Mailing Address - Phone:304-424-6363
Mailing Address - Fax:304-422-7396
Practice Address - Street 1:4015 E 7TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-3869
Practice Address - Country:US
Practice Address - Phone:304-424-6363
Practice Address - Fax:304-422-7396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0220540Medicaid
WV0147983000Medicaid
WV001705416OtherBCBS PROVIDER NUMBER
WV0147983000Medicaid