Provider Demographics
NPI:1841460367
Name:HAROLD MOORE
Entity type:Organization
Organization Name:HAROLD MOORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:970-472-8700
Mailing Address - Street 1:1217 E ELIZABETH ST
Mailing Address - Street 2:SUITE #11
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4040
Mailing Address - Country:US
Mailing Address - Phone:970-472-8700
Mailing Address - Fax:970-224-5805
Practice Address - Street 1:1217 E ELIZABETH ST
Practice Address - Street 2:SUITE #11
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4040
Practice Address - Country:US
Practice Address - Phone:970-472-8700
Practice Address - Fax:970-224-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO339332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0567960003Medicare NSC