Provider Demographics
NPI:1881880144
Name:MORRILL MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:MORRILL MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ROY
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 # C
Mailing Address - Street 2:120
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 # C
Practice Address - Street 2:120
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:2007-09-20
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F6517Medicare PIN
TX00Y353Medicare PIN