Provider Demographics
NPI:1295912566
Name:DR. MARC MORRIS
Entity type:Organization
Organization Name:DR. MARC MORRIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-282-2040
Mailing Address - Street 1:49 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1928
Mailing Address - Country:US
Mailing Address - Phone:570-282-2040
Mailing Address - Fax:570-282-2040
Practice Address - Street 1:49 SALEM AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1928
Practice Address - Country:US
Practice Address - Phone:570-282-2040
Practice Address - Fax:570-282-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0504802Medicaid
PA149657Medicare PIN
PA0504802Medicaid
PA0493340001Medicare NSC