=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881610442
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EWING & MORRIS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2006
-----------------------------------------------------
Last Update Date | 11/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 850 TUCK ST
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17042-7477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-272-8173
-----------------------------------------------------
Fax | 717-272-8422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 850 TUCK ST
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17042-7477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-272-8173
-----------------------------------------------------
Fax | 717-272-8422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILSON MORRIS
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 717-272-8173
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | OS003449L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | OS004587L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | OS004587L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | OS003439L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | OS003449L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------