Basic Information
Provider Information | |||||||||
NPI: | 1225071046 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MORRIS | ||||||||
FirstName: | ERIC | ||||||||
MiddleName: | V. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 633819 | ||||||||
Address2: |   | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452630001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8652923000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 100 NORTHCREST DR | ||||||||
Address2: |   | ||||||||
City: | SPRINGFIELD | ||||||||
State: | TN | ||||||||
PostalCode: | 371723927 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6153841536 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/13/2006 | ||||||||
LastUpdateDate: | 11/12/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 023739 | TN | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 3040738 | 01 | TN | BLUECROSS | OTHER | 4100206 | 01 | TN | BLUECROSS | OTHER | 3071491 | 05 | TN |   | MEDICAID | 64097660 | 05 | KY |   | MEDICAID | P00287015 | 01 | TN | RAILROAD MEDICARE | OTHER | 4151484 | 01 | TN | BLUECROSS | OTHER | 3071499 | 05 | TN |   | MEDICAID | 30711490 | 05 | TN |   | MEDICAID | P00367245 | 01 | TN | RAILROAD MEDICARE | OTHER |