Provider Demographics
NPI:1598798084
Name:STEVEN A MOORE
Entity Type:Organization
Organization Name:STEVEN A MOORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-336-0999
Mailing Address - Street 1:2308 ENTERPRISE AVE
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-7188
Mailing Address - Country:US
Mailing Address - Phone:712-336-0999
Mailing Address - Fax:712-336-9222
Practice Address - Street 1:2308 ENTERPRISE AVE
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-7188
Practice Address - Country:US
Practice Address - Phone:712-336-0999
Practice Address - Fax:712-336-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0278085Medicaid
IAF242865OtherMIDLANDS CHOICE
IA31401OtherBLUE CROSS BLUE SHIELD
IA31401OtherBLUE CROSS BLUE SHIELD