1437147147 NPI number — ISAAC MOORE MD

Table of content: (NPI 1437147147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437147147 NPI number — ISAAC MOORE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISAAC MOORE MD
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:
ALPHA EYE CLINIC
Provider Other Organization Name Type Code:
3
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:
1437147147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13029
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32317-3029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-385-0033
Provider Business Mailing Address Fax Number:
850-422-0201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2160 CAPITAL CIR NE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308-4390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-385-0033
Provider Business Practice Location Address Fax Number:
850-422-0201
Provider Enumeration Date:
10/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
ISAAC
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
850-385-0033

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  ME 31862 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00389496A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 039263400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 406182936 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 406182936 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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