MEDICARE: JASON KENDELL MORRIS M.D.

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	2085B0100X	Body Imaging Physician	E-0389	AR
2	2085B0100X	Body Imaging Physician	14181	MS
3	2085B0100X	Body Imaging Physician	MD.200141	LA
4	2085B0100X	Body Imaging Physician	049069	GA
5	2085B0100X	Body Imaging Physician	693403	TN
6	2085R0204X	Vascular & Interventional Radiology Physician	14181	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	300126521	OTHER	MS	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5M809	OTHER	AR	BLUE CROSS/ BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790720779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON KENDELL MORRIS M.D.

Provider Business Mailing Address
First Line	:	618 FREDERICK DR
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2006
Country	:	US
Telephone Number	:	662-299-2999
Fax Number	:	662-846-8989

Provider Business Practice Location Address
First Line	:	618 FREDERICK DR
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2006
Country	:	US
Telephone Number	:	662-299-2999
Fax Number	:	662-846-8989

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	10/17/2013

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