Provider Demographics
NPI:1700846888
Name:MOORE CARE AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:MOORE CARE AMBULANCE SERVICE LLC
Other - Org Name:MOORE CARE AMBULANCE SERVICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-766-1500
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:TN
Mailing Address - Zip Code:38469
Mailing Address - Country:US
Mailing Address - Phone:931-766-1500
Mailing Address - Fax:931-766-4002
Practice Address - Street 1:1601 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464
Practice Address - Country:US
Practice Address - Phone:931-766-1500
Practice Address - Fax:931-766-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS0000009970341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3572232Medicaid
TN3572232Medicaid