Provider Demographics
NPI:1043205156
Name:HALL-MOORE MEDICAL SUPPLEIS, INC
Entity Type:Organization
Organization Name:HALL-MOORE MEDICAL SUPPLEIS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-731-7212
Mailing Address - Street 1:6539 POWERS AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2888
Mailing Address - Country:US
Mailing Address - Phone:904-731-7212
Mailing Address - Fax:904-731-5853
Practice Address - Street 1:6539 POWERS AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2888
Practice Address - Country:US
Practice Address - Phone:904-731-7212
Practice Address - Fax:904-731-5853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1409332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1409OtherSTATE LICENSE NUMBER
FL0623480001Medicare NSC