Provider Demographics
NPI:1255888095
Name:MOORE DME LLC
Entity type:Organization
Organization Name:MOORE DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-269-7510
Mailing Address - Street 1:403 LORD LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-8977
Mailing Address - Country:US
Mailing Address - Phone:870-269-7510
Mailing Address - Fax:870-269-7511
Practice Address - Street 1:403 LORD LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-8977
Practice Address - Country:US
Practice Address - Phone:870-269-7510
Practice Address - Fax:870-269-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies