Provider Demographics
NPI:1114953247
Name:TERENCE E. MOORE
Entity Type:Organization
Organization Name:TERENCE E. MOORE
Other - Org Name:FAMILY MEDICAL CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-763-3251
Mailing Address - Street 1:710 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-1103
Mailing Address - Country:US
Mailing Address - Phone:724-763-3251
Mailing Address - Fax:
Practice Address - Street 1:710 4TH AVE
Practice Address - Street 2:
Practice Address - City:FORD CITY
Practice Address - State:PA
Practice Address - Zip Code:16226-1103
Practice Address - Country:US
Practice Address - Phone:724-763-3251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRMD039455L261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010047480002Medicaid
PA516724OtherBLUE SHIELD PROV NUMBER
PA080126969Medicare PIN
PA0010047480002Medicaid