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NPI Code Detail

MEDICARE: SUSAN L. MOREHOUSE-MOORE P.A.C

MEDICARE: SUSAN L. MOREHOUSE-MOORE P.A.C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant507SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356399570
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN L. MOREHOUSE-MOORE P.A.C
Provider Business Mailing Address
First Line : 800 N FANT ST
Second Line :
City : ANDERSON
State : SC
Zip : 29621-5708
Country : US
Telephone Number : 864-512-1417
Fax Number : 864-512-1823
Provider Business Practice Location Address
First Line : 1 SAINT FRANCIS DR
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-3955
Country : US
Telephone Number : 864-255-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 05/26/2021

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