Provider Demographics
NPI:1114220621
Name:MOORE CARE PROVIDERS
Entity Type:Organization
Organization Name:MOORE CARE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKBIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-564-8529
Mailing Address - Street 1:1738 WYNKOOP ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-5925
Mailing Address - Country:US
Mailing Address - Phone:303-564-8529
Mailing Address - Fax:
Practice Address - Street 1:1738 WYNKOOP ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-5925
Practice Address - Country:US
Practice Address - Phone:303-564-8529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty