1043405566 NPI number — OHIO HEARTLAND COMMUNITY ACTIOM COMMISSION

Table of content: HARRY FRANCIS MOORE JR. M.D. (NPI 1699096388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043405566 NPI number — OHIO HEARTLAND COMMUNITY ACTIOM COMMISSION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OHIO HEARTLAND COMMUNITY ACTIOM COMMISSION
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:
1043405566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
372 E CENTER ST
Provider Second Line Business Mailing Address:
BOX 779
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43302-4126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
372 E CENTER ST
Provider Second Line Business Practice Location Address:
BOX 779
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43302-4126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-387-1039
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAVELLE
Authorized Official First Name:
JIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
740-387-1039

Provider Taxonomy Codes

  • Taxonomy code: 332U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 17086548 . This is a "PASSPORT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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