Healthcare Provider Details

I. General information

NPI: 1992991483
Provider Name (Legal Business Name): MOORE FAMILY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 MCFARLAND BLVD STE 103
NORTHPORT AL
35476-3262
US

IV. Provider business mailing address

1325 MCFARLAND BLVD STE 103
NORTHPORT AL
35476-3262
US

V. Phone/Fax

Practice location:
  • Phone: 205-330-4989
  • Fax:
Mailing address:
  • Phone: 205-330-4989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number25444
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25444
License Number StateAL

VIII. Authorized Official

Name: DR. KAREN STACY MOORE
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 205-330-4989