Provider Demographics
NPI:1134598287
Name:MOORE ORTHOPEDICS AND SPORTS MEDICINE
Entity type:Organization
Organization Name:MOORE ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:DOOLITTLE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-808-3100
Mailing Address - Street 1:4218 ARENDELL ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2866
Mailing Address - Country:US
Mailing Address - Phone:252-808-3100
Mailing Address - Fax:252-808-3120
Practice Address - Street 1:1165 CEDAR POINT BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-8023
Practice Address - Country:US
Practice Address - Phone:252-808-4440
Practice Address - Fax:252-764-2442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOORE ORTHOPEDICS AND SPORTS MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32801174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913911Medicaid
NC208978AMedicare Oscar/Certification
NC5913911Medicaid