Provider Demographics
NPI:1942212600
Name:MORROW, MARCY LIN (PAC)
Entity type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:LIN
Last Name:MORROW
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 4TH AVE W
Mailing Address - Street 2:GOODING FAMILY PHYSICIANS
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330
Mailing Address - Country:US
Mailing Address - Phone:208-934-4446
Mailing Address - Fax:208-934-4442
Practice Address - Street 1:134 4TH AVE W
Practice Address - Street 2:GOODING FAMILY PHYSICIANS
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330
Practice Address - Country:US
Practice Address - Phone:208-934-4446
Practice Address - Fax:208-934-4442
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA581363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807316800Medicaid
ID806777400Medicaid
Q59069Medicare UPIN
ID807316800Medicaid
ID1667334Medicare ID - Type Unspecified