=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447564018
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. JAMES THOMAS MORRIS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2010
-----------------------------------------------------
Last Update Date | 08/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 512 N HICKORY RD
-----------------------------------------------------
City | ATOKA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74525-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-618-5108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 512 N HICKORY RD
-----------------------------------------------------
City | ATOKA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74525-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-618-5108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------