| Moore Primary Care | |
|
1400 Se 4th St Suite H Moore OK 73160-7329 | |
| (405) 799-7400 | |
| (405) 799-7405 |
| Full Name | Moore Primary Care |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1400 Se 4th St, Moore, Oklahoma |
| Authorized Official Name and Position | Randall Carter (PA-C) |
| Authorized Official Contact | 4057997400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Moore Primary Care 1400 Se 4th St Suite H Moore OK 73160-7329 Ph: (405) 799-7400 | Moore Primary Care 1400 Se 4th St Suite H Moore OK 73160-7329 Ph: (405) 799-7400 |
| NPI Number | 1578854576 |
|---|---|
| Provider Enumeration Date | 04/25/2011 |
| Last Update Date | 04/25/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578854576 | NPI | - | NPPES |
| 200079670A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
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