Provider Demographics
NPI:1609869247
Name:MOORE LIFE ENTERPRISES INC
Entity Type:Organization
Organization Name:MOORE LIFE ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-837-3445
Mailing Address - Street 1:916 QUAIL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5806
Mailing Address - Country:US
Mailing Address - Phone:615-364-4158
Mailing Address - Fax:615-837-3445
Practice Address - Street 1:1412 COUNTY HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37218-3007
Practice Address - Country:US
Practice Address - Phone:615-364-4158
Practice Address - Fax:615-837-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3724343Medicaid
TN3724343Medicare ID - Type Unspecified