Provider Demographics
NPI:1881944163
Name:MORRISON MEDICAL ENTERPRISES
Entity type:Organization
Organization Name:MORRISON MEDICAL ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:JON
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-255-8645
Mailing Address - Street 1:1307 PORTER WAGONER BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1828
Mailing Address - Country:US
Mailing Address - Phone:417-255-8645
Mailing Address - Fax:417-255-8649
Practice Address - Street 1:1307 PORTER WAGONER BLVD
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1828
Practice Address - Country:US
Practice Address - Phone:417-255-8645
Practice Address - Fax:417-255-8649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010028285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty