Provider Demographics
NPI:1104379148
Name:MOORE CARE LLC
Entity Type:Organization
Organization Name:MOORE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEPPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-928-2727
Mailing Address - Street 1:400 N EASTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5833
Mailing Address - Country:US
Mailing Address - Phone:405-928-2727
Mailing Address - Fax:405-928-2720
Practice Address - Street 1:400 N EASTERN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5833
Practice Address - Country:US
Practice Address - Phone:405-928-2727
Practice Address - Fax:405-928-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care