MEDICARE: MOORE HEALTH SERVICES CORPORATION

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
1	314000000X	Skilled Nursing Facility	111093	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1467439299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOORE HEALTH SERVICES CORPORATION

Provider Business Mailing Address
First Line	:	2611 W 46TH AVE
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79110-1735
Country	:	US
Telephone Number	:	803-355-6517
Fax Number	:	806-355-4190

Provider Business Practice Location Address
First Line	:	2611 W 46TH AVE
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79110-1735
Country	:	US
Telephone Number	:	803-355-6517
Fax Number	:	806-355-4190

Authorized Official
Title or Position	:	REGIONAL ADMINISTRATOR
Name	:	MRS. ANGELIN DICKSON
Credential	:	LNFA
Telephone Number	:	806-259-3566

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	12/12/2008

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Directions to “MOORE HEALTH SERVICES CORPORATION ” Practice Location

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