1811214190 NPI number — MARCIA S. MOORE, PH.D., PLC

Table of content: (NPI 1811214190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811214190 NPI number — MARCIA S. MOORE, PH.D., PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARCIA S. MOORE, PH.D., PLC
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:
1811214190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4140 W MEMORIAL RD
Provider Second Line Business Mailing Address:
STE. 221
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73120-8366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-755-5801
Provider Business Mailing Address Fax Number:
405-755-5949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4140 W MEMORIAL RD
Provider Second Line Business Practice Location Address:
STE. 221
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73120-8366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-755-5801
Provider Business Practice Location Address Fax Number:
405-755-5949
Provider Enumeration Date:
04/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
405-755-5801

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  415 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1194739102 . This is a "NPI INDIVIDUAL NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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