Provider Demographics
NPI:1528148673
Name:MORRIS MEDICAL CENTER, P.A.
Entity type:Organization
Organization Name:MORRIS MEDICAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DARELD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:863-675-3427
Mailing Address - Street 1:45 BRYAN AVE
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-4647
Mailing Address - Country:US
Mailing Address - Phone:863-675-3427
Mailing Address - Fax:863-675-3809
Practice Address - Street 1:45 BRYAN AVE
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4647
Practice Address - Country:US
Practice Address - Phone:863-675-3427
Practice Address - Fax:863-675-3809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80753OtherBCBS PROVIDER NUMBER
FLF48541Medicare UPIN
FL80753CMedicare ID - Type Unspecified