Provider Demographics
NPI:1336392299
Name:SAMUEL D MORRIS
Entity Type:Organization
Organization Name:SAMUEL D MORRIS
Other - Org Name:S. DAVID MORRIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BLENKER
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:304-263-8911
Mailing Address - Street 1:92 HALIFAX CT
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-5075
Mailing Address - Country:US
Mailing Address - Phone:304-267-3810
Mailing Address - Fax:
Practice Address - Street 1:209 CLOVER ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3803
Practice Address - Country:US
Practice Address - Phone:304-263-8921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12716313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0057046000Medicaid
WV080020708OtherRAILROAD INDIVIDUAL ID#
WV0522433Medicare PIN