Provider Demographics
NPI:1467502567
Name:JEFFREY S. MOORE MD AND ELISHA T. POWELL IV MD LLC
Entity Type:Organization
Organization Name:JEFFREY S. MOORE MD AND ELISHA T. POWELL IV MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-862-2663
Mailing Address - Street 1:PO BOX 772292
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-2292
Mailing Address - Country:US
Mailing Address - Phone:907-862-2663
Mailing Address - Fax:907-222-1774
Practice Address - Street 1:2751 DEBARR RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2953
Practice Address - Country:US
Practice Address - Phone:907-279-2663
Practice Address - Fax:907-222-1774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3797207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK160654Medicare ID - Type UnspecifiedDR.JEFFREY MOORE MEDICARE
AKQ67220Medicare UPIN
AKK160649Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER