Healthcare Provider Details

I. General information

NPI: 1144036690
Provider Name (Legal Business Name): MOORE TRANPORT SERVICES MTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 MISSISSIPPI AVE
GREENWOOD MS
38930-5220
US

IV. Provider business mailing address

907 MISSISSIPPI AVE
GREENWOOD MS
38930-5220
US

V. Phone/Fax

Practice location:
  • Phone: 662-458-1982
  • Fax:
Mailing address:
  • Phone: 662-458-1982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. FREDERICK EARL MOORE JR.
Title or Position: OWNER
Credential:
Phone: 662-458-1982