Provider Demographics
NPI:1972154748
Name:MORRILL MEDICAL MOBILE SERVICES PA
Entity Type:Organization
Organization Name:MORRILL MEDICAL MOBILE SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORRILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-303-0861
Mailing Address - Street 1:4125 BROADWAY BLVD STE 120C
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2500
Mailing Address - Country:US
Mailing Address - Phone:972-303-0861
Mailing Address - Fax:972-303-0928
Practice Address - Street 1:4125 BROADWAY BLVD STE 120C
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2500
Practice Address - Country:US
Practice Address - Phone:972-303-0861
Practice Address - Fax:972-303-0928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty