Provider Demographics
NPI:1336257518
Name:MORTON CLINIC
Entity Type:Organization
Organization Name:MORTON CLINIC
Other - Org Name:MORTON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KODY
Authorized Official - Middle Name:
Authorized Official - Last Name:KITCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-266-5566
Mailing Address - Street 1:201 E GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:TX
Mailing Address - Zip Code:79346-3444
Mailing Address - Country:US
Mailing Address - Phone:806-266-5566
Mailing Address - Fax:806-266-5564
Practice Address - Street 1:201 E GRANT AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:TX
Practice Address - Zip Code:79346
Practice Address - Country:US
Practice Address - Phone:806-266-5566
Practice Address - Fax:806-266-5564
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COCHRAN MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-28
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000159261QR1300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121145004Medicaid
TX121145002Medicaid
TX121145002Medicaid
TX094152801Medicaid