Provider Demographics
NPI:1447593439
Name:MOORE SURGICAL ASSISTING, LLC
Entity Type:Organization
Organization Name:MOORE SURGICAL ASSISTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:970-629-2135
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-0602
Mailing Address - Country:US
Mailing Address - Phone:970-629-2135
Mailing Address - Fax:888-329-6432
Practice Address - Street 1:674 MESA CT
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-2529
Practice Address - Country:US
Practice Address - Phone:970-629-2135
Practice Address - Fax:888-329-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO124936OtherCSFA CERTIFICATE