1518993310 NPI number — LASHONDA MOORE DPM

Table of content: LASHONDA MOORE DPM (NPI 1518993310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518993310 NPI number — LASHONDA MOORE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
LASHONDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

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:
1518993310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 FORT DALE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36037-1502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-382-1400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 FORT DALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36037-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-382-1400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  261 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 051533097 . This is a "BC MONTGOMERY OFFICE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051532094 . This is a "BC CEDARS ASSISTED LIVING" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 890014860 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00289903 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051532095 . This is a "BC ELMCROFT ASSISTED LIVI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 890014840 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 890014890 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051532088 . This is a "BC GREENVILLE OFFICE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051532089 . This is a "BC SNF SUNBRIDGE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051532090 . This is a "BC SNF BELLMONT ASSISTED" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051532091 . This is a "BC HILLABER TOWERS ALEX C" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 891011570 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 891011610 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051533098 . This is a "BC CLANTON OFFICE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 891011600 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 891011620 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051532092 . This is a "BC COUNTY CLUB MANOR WETU" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 890014810 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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