Provider Demographics
NPI:1861896003
Name:MOORE MEDICAL
Entity type:Organization
Organization Name:MOORE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-705-9650
Mailing Address - Street 1:198 OKATIE VILLAGE DR
Mailing Address - Street 2:SUITE 103, BOX 104
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7527
Mailing Address - Country:US
Mailing Address - Phone:843-705-9650
Mailing Address - Fax:
Practice Address - Street 1:198 OKATIE VILLAGE DR
Practice Address - Street 2:SUITE 103, BOX 104
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7527
Practice Address - Country:US
Practice Address - Phone:843-705-9650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies