MEDICARE: MR. ADAM RICHARD MORRIS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WM0705X	Medical-Surgical Registered Nurse	354186	OH
2	164X00000X	Licensed Vocational Nurse	208988	TX

General Provider Information

NPI Number	:	1003107574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADAM RICHARD MORRIS RN

Provider Business Mailing Address
First Line	:	2875 LANGDON FARM RD.
Second Line	:	APT #4
City	:	CINCINNATI
State	:	OH
Zip	:	45212
Country	:	US
Telephone Number	:	513-658-2729
Fax Number	:

Provider Business Practice Location Address
First Line	:	2875 LANGDON FARM RD
Second Line	:	APT 4
City	:	CINCINNATI
State	:	OH
Zip	:	45212-1337
Country	:	US
Telephone Number	:	513-658-2729
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	05/02/2011

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