# MORENCI MEDICAL ASSOC, PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MORENCI MEDICAL ASSOC, PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1962690735
- **Legal business name:** MORENCI MEDICAL ASSOC, PC
- **Authorized official:** DR. SHIVAPRASAS K SHETTY MD (PRESIDENT)
- **Authorized official phone:** (419) 335-2811

## Contact information

- **Practice address:** 137 S FULTON ST, WAUSEON, OH 43567-1351
- **Practice address phone:** (419) 335-2811
- **Practice address fax:** (419) 335-3388
- **Mailing address:** 137 S FULTON ST, WAUSEON, OH 43567-1351
- **Mailing address phone:** (419) 335-2811
- **Mailing address fax:** (419) 335-3388

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 35-06-8087S | OH | Yes |

## Other

- **Enumeration date:** 10/05/2007
- **Last updated:** 10/05/2007