Healthcare Provider Details

I. General information

NPI: 1699183756
Provider Name (Legal Business Name): MOORE MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 SAINT ANDREWS DR SUITE 106
MURFREESBORO TN
37128-6578
US

IV. Provider business mailing address

490 SAINT ANDREWS DR SUITE 106
MURFREESBORO TN
37128-6578
US

V. Phone/Fax

Practice location:
  • Phone: 615-896-4482
  • Fax: 615-896-4472
Mailing address:
  • Phone: 615-896-4482
  • Fax: 615-896-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7533
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number7885
License Number StateTN

VIII. Authorized Official

Name: TIMOTHY MOORE
Title or Position: PRESIDENT
Credential: NP
Phone: 615-896-4482