1538326517 NPI number — ANDREW L MOORE JR MS PC

Table of content: (NPI 1538326517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538326517 NPI number — ANDREW L MOORE JR MS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDREW L MOORE JR MS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538326517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 968
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAFFORD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-659-7515
Provider Business Mailing Address Fax Number:
540-659-7515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2063 JEFFERSON DAVIS HWY
Provider Second Line Business Practice Location Address:
SUITE ONE
Provider Business Practice Location Address City Name:
STAFFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-659-7515
Provider Business Practice Location Address Fax Number:
540-659-7515
Provider Enumeration Date:
05/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
LEWIS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
540-659-7515

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  041006050 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 686682 . This is a "CARENET" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 104019 . This is a "UNITED CON TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 291871 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7804148 . This is a "SMILES" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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