Provider Demographics
NPI:1861449621
Name:CHRISTINE L MOORE DO PC
Entity Type:Organization
Organization Name:CHRISTINE L MOORE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-322-0701
Mailing Address - Street 1:6325 BLUE RIDGE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4886
Mailing Address - Country:US
Mailing Address - Phone:816-322-0701
Mailing Address - Fax:816-322-2035
Practice Address - Street 1:6325 BLUE RIDGE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-4886
Practice Address - Country:US
Practice Address - Phone:816-322-0701
Practice Address - Fax:816-322-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO25009021OtherBCBS OF KC
MOI300000AMedicare ID - Type Unspecified