Provider Demographics
NPI:1184687931
Name:MOORE MEDICAL INC
Entity Type:Organization
Organization Name:MOORE MEDICAL INC
Other - Org Name:PONTCHARTRAIN ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-869-2377
Mailing Address - Street 1:4061 HIGHWAY 59 STE C
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1906
Mailing Address - Country:US
Mailing Address - Phone:985-629-0960
Mailing Address - Fax:985-629-0964
Practice Address - Street 1:4061 HIGHWAY 59 STE C
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1906
Practice Address - Country:US
Practice Address - Phone:985-629-0960
Practice Address - Fax:985-629-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
LACO004273335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3923970001Medicare NSC