MEDICARE: MOORE HEALTHCARE, INC.

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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	52-4094	OK
2	332BX2000X	Oxygen Equipment & Supplies (DME)	52-S-1138	OK
3	3336C0003X	Community/Retail Pharmacy	52-4094	OK
4	332B00000X	Durable Medical Equipment & Medical Supplies		OK

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3700499	OTHER	OK	PHARMACY NCPDP NUMBER

General Provider Information

NPI Number	:	1417001272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOORE HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	301 N BROADWAY ST
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-3421
Country	:	US
Telephone Number	:	918-358-2524
Fax Number	:	918-358-2588

Provider Business Practice Location Address
First Line	:	301 N BROADWAY ST
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-3421
Country	:	US
Telephone Number	:	918-358-2524
Fax Number	:	918-358-2588

Authorized Official
Title or Position	:	MANAGER
Name	:	GREGORY P MOORE
Credential	:
Telephone Number	:	918-358-2587

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	02/07/2022

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Directions to “MOORE HEALTHCARE, INC. ” Practice Location

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