1588653794 NPI number — REMIS MARK MOORE PA-C

Table of content: REMIS MARK MOORE PA-C (NPI 1588653794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588653794 NPI number — REMIS MARK MOORE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
REMIS
Provider Middle Name:
MARK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

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:
1588653794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT. #394
Provider Second Line Business Mailing Address:
P.O. BOX 1000
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38148-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-300-4440
Provider Business Mailing Address Fax Number:
941-404-1760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 MATLOCK CENTRE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76015-2535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-693-1000
Provider Business Practice Location Address Fax Number:
866-950-0295
Provider Enumeration Date:
10/19/2005

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PA9117098 . This is a "FL DOH LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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