Provider Demographics
NPI:1932387180
Name:SETH MOYER SUPPORT MICROBOARD, INC.
Entity Type:Organization
Organization Name:SETH MOYER SUPPORT MICROBOARD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-635-8338
Mailing Address - Street 1:7665 FM 327
Mailing Address - Street 2:
Mailing Address - City:ELMENDORF
Mailing Address - State:TX
Mailing Address - Zip Code:78112-9808
Mailing Address - Country:US
Mailing Address - Phone:210-635-8339
Mailing Address - Fax:210-635-8339
Practice Address - Street 1:7665 FM 327
Practice Address - Street 2:
Practice Address - City:ELMENDORF
Practice Address - State:TX
Practice Address - Zip Code:78112-9808
Practice Address - Country:US
Practice Address - Phone:210-635-8339
Practice Address - Fax:210-635-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX315P00000XMedicaid