Provider Demographics
NPI:1770909160
Name:MORTON & BROWN LLC
Entity type:Organization
Organization Name:MORTON & BROWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO,LMT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFANI
Authorized Official - Middle Name:MEGAN
Authorized Official - Last Name:REVELS LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:863-443-3168
Mailing Address - Street 1:2445 W HAVILAND RD
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-8352
Mailing Address - Country:US
Mailing Address - Phone:863-443-3168
Mailing Address - Fax:
Practice Address - Street 1:3625 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4864
Practice Address - Country:US
Practice Address - Phone:863-443-3168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA74492261QM2500X
FLMA65750261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty