Provider Demographics
NPI:1083773709
Name:MOA MEDICAL MANAGEMENT, LLC
Entity Type:Organization
Organization Name:MOA MEDICAL MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:GRADY
Authorized Official - Middle Name:LAWSON
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-682-6743
Mailing Address - Street 1:PO BOX 108809
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-8809
Mailing Address - Country:US
Mailing Address - Phone:972-479-1115
Mailing Address - Fax:972-479-1118
Practice Address - Street 1:5920 FOREST PARK RD
Practice Address - Street 2:STE. 560
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218
Practice Address - Country:US
Practice Address - Phone:214-350-0708
Practice Address - Fax:214-350-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty