Provider Demographics
NPI:1063558583
Name:MORNINGSIDE MINISTRIES
Entity type:Organization
Organization Name:MORNINGSIDE MINISTRIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-731-1199
Mailing Address - Street 1:602 BABCOCK RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-3101
Mailing Address - Country:US
Mailing Address - Phone:210-731-1199
Mailing Address - Fax:210-731-1081
Practice Address - Street 1:602 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-3101
Practice Address - Country:US
Practice Address - Phone:210-731-1199
Practice Address - Fax:210-731-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336I0012X, 333600000X, 3336C0003X
TX136043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370016Medicaid
2100457OtherPK