1184864076 NPI number — DR. ANGELA SUE MOORE DO

Table of content: DR. ANGELA SUE MOORE DO (NPI 1184864076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184864076 NPI number — DR. ANGELA SUE MOORE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
ANGELA
Provider Middle Name:
SUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
D'ANNUNZIO
Provider Other First Name:
ANGELA
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184864076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3510 N RIDGE ROAD, SUITE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-881-8180
Provider Business Mailing Address Fax Number:
316-881-8239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3510 N RIDGE ROAD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-881-8180
Provider Business Practice Location Address Fax Number:
316-881-8329
Provider Enumeration Date:
03/05/2009

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: 207Q00000X , with the licence number:  0534062 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 47165 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200639670A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1184864076 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com