Basic Information
| Provider Information | |||||||||
| NPI: | 1396735387 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MORTON EMERGENCY ASSOC PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 TOTTEN POND RD | ||||||||
| Address2: | C/O MZI | ||||||||
| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024511991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818909933 | ||||||||
| FaxNumber: | 7818909950 | ||||||||
| Practice Location | |||||||||
| Address1: | 88 WASHINGTON ST | ||||||||
| Address2: | ATTN EMERGENCY DEPT | ||||||||
| City: | TAUNTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027802465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088287108 | ||||||||
| FaxNumber: | 5088287158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BECKER | ||||||||
| AuthorizedOfficialFirstName: | STEPHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EMERGENCY MED | ||||||||
| AuthorizedOfficialTelephone: | 5088287108 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | M17577 | 01 | MA | BCBS | OTHER | G87228 | 01 | MA | TUFTS | OTHER | 9701753 | 05 | MA | MEDICAID |