Provider Demographics
NPI:1801829304
Name:STEVEN A. MOORE
Entity Type:Organization
Organization Name:STEVEN A. MOORE
Other - Org Name:DBA LAKES OXYGEN AND RESPIRATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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 1:115 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4224
Mailing Address - Country:US
Mailing Address - Phone:712-262-7838
Mailing Address - Fax:712-262-0055
Practice Address - Street 1:115 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4224
Practice Address - Country:US
Practice Address - Phone:712-262-7838
Practice Address - Fax:712-262-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1005050001Medicare ID - Type Unspecified