Provider Demographics
NPI:1174720981
Name:MOORE FAMILY MEDICAL PLC
Entity type:Organization
Organization Name:MOORE FAMILY MEDICAL PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-896-4482
Mailing Address - Street 1:115 N THOMPSON LN
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-4305
Mailing Address - Country:US
Mailing Address - Phone:615-896-4482
Mailing Address - Fax:615-896-4472
Practice Address - Street 1:115 N THOMPSON LN
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4305
Practice Address - Country:US
Practice Address - Phone:615-896-4482
Practice Address - Fax:615-896-4472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3718182Medicare PIN