Healthcare Provider Details

I. General information

NPI: 1104827633
Provider Name (Legal Business Name): MORGAN PHYSICIAN SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 JOHN R WOODEN DR SUITE 201
MARTINSVILLE IN
46151-1838
US

IV. Provider business mailing address

PO BOX 1557
MARTINSVILLE IN
46151-0557
US

V. Phone/Fax

Practice location:
  • Phone: 765-349-4600
  • Fax: 765-349-6590
Mailing address:
  • Phone: 765-349-4600
  • Fax: 765-349-6590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT J. PHILLIPS
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 765-349-6500