Healthcare Provider Details

I. General information

NPI: 1548631237
Provider Name (Legal Business Name): MORGAN MIRACLE RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1632 CUMBERLAND AVE SUITE 1
MIDDLESBORO KY
40965-1378
US

IV. Provider business mailing address

1632 CUMBERLAND AVE SUITE 1
MIDDLESBORO KY
40965-1378
US

V. Phone/Fax

Practice location:
  • Phone: 606-302-4309
  • Fax: 606-766-0808
Mailing address:
  • Phone: 606-302-4309
  • Fax: 606-766-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number3782
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: