Provider Demographics
NPI:1770767790
Name:FRANCISCO G. MORENO, M.D., P.C.
Entity type:Organization
Organization Name:FRANCISCO G. MORENO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE, CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-546-2888
Mailing Address - Street 1:501 20TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1850
Mailing Address - Country:US
Mailing Address - Phone:865-546-2888
Mailing Address - Fax:865-546-5606
Practice Address - Street 1:501 20TH ST STE 201
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1850
Practice Address - Country:US
Practice Address - Phone:865-546-2888
Practice Address - Fax:865-546-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000010436174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3187241Medicaid
TN3187241Medicare PIN
TN3187241Medicaid