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NPI Code Detail

MEDICARE: DR. STACIA ADAIR MOORE AU.D.

MEDICARE:  DR. STACIA ADAIR MOORE  AU.D.
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
1231H00000XAudiologistAU795MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3290408OTHERMTBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1851394902
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACIA ADAIR MOORE AU.D.
Provider Business Mailing Address
First Line : 10 THREE MILE DR
Second Line :
City : KALISPELL
State : MT
Zip : 59901-3034
Country : US
Telephone Number : 406-257-2273
Fax Number : 406-257-7755
Provider Business Practice Location Address
First Line : 10 THREE MILE DR
Second Line :
City : KALISPELL
State : MT
Zip : 59901-3034
Country : US
Telephone Number : 406-257-2273
Fax Number : 406-257-7755
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 10/20/2011

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Directions to “ DR. STACIA ADAIR MOORE AU.D.” Practice Location

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