1568602803 NPI number — RHC F ALLEN MOORHEAD JR MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568602803 NPI number — RHC F ALLEN MOORHEAD JR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RHC F ALLEN MOORHEAD JR 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:
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:
1568602803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 180
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEODESHA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66757-0180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-325-2200
Provider Business Mailing Address Fax Number:
620-325-2410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
709 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEODESHA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66757-1634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-325-2200
Provider Business Practice Location Address Fax Number:
620-325-2410
Provider Enumeration Date:
02/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SHIELDS
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
620-325-2200

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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