Provider Demographics
NPI:1285301762
Name:MORTON, DEREK SR
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:
Last Name:MORTON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MEDI-RYDE,
Other - Middle Name:
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:248 CHAMPIONS RDG
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6200
Mailing Address - Country:US
Mailing Address - Phone:214-454-3602
Mailing Address - Fax:
Practice Address - Street 1:10615 PERRIN BEITEL RD, BLDG 4
Practice Address - Street 2:SUITE 410
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-7821
Practice Address - Country:US
Practice Address - Phone:214-454-3602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)