Provider Demographics
NPI:1245329705
Name:GARRISON V. MORIN DBA MOUNTAIN STATE ENT CENTER
Entity type:Organization
Organization Name:GARRISON V. MORIN DBA MOUNTAIN STATE ENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRISON
Authorized Official - Middle Name:VASILE
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-267-0235
Mailing Address - Street 1:321 LUTZ AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-6362
Mailing Address - Country:US
Mailing Address - Phone:304-267-0235
Mailing Address - Fax:304-267-0237
Practice Address - Street 1:321 LUTZ AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-6362
Practice Address - Country:US
Practice Address - Phone:304-267-0235
Practice Address - Fax:304-267-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21819207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001886Medicaid
P00212257OtherMORIN MCARE RAILROAD INDI
WV2132881OtherMORIN MAMSI INDIVIDUAL
1003874934OtherMORIN NPI
DD1745OtherMEDICARE RAILROAD: GROUP
WV7926704OtherMORIN AETNA INDIVIDUAL #
P00212257OtherMORIN MCARE RAILROAD INDI
WV2132881OtherMORIN MAMSI INDIVIDUAL
WV7926704OtherMORIN AETNA INDIVIDUAL #