Provider Demographics
NPI:1558582387
Name:MOORE MEDICAL CENTER
Entity Type:Organization
Organization Name:MOORE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-307-1051
Mailing Address - Street 1:700 S TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2502
Mailing Address - Country:US
Mailing Address - Phone:405-793-9355
Mailing Address - Fax:405-912-3531
Practice Address - Street 1:700 S TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2502
Practice Address - Country:US
Practice Address - Phone:405-793-9355
Practice Address - Fax:405-912-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7-51543336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7-5154OtherSTATE PHARMACY LICENSE
OK7-5154OtherSTATE PHARMACY LICENSE