MEDICARE: GEORGE MOORE

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	207Q00000X	Family Medicine Physician	5711	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00169807	OTHER	SC	RAILROAD MEDICARE PTAN

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

General Provider Information

NPI Number	:	1457464554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE MOORE

Provider Business Mailing Address
First Line	:	225 S MAIN ST
Second Line	:
City	:	MC COLL
State	:	SC
Zip	:	29570-2020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 S MAIN ST
Second Line	:
City	:	MC COLL
State	:	SC
Zip	:	29570-2020
Country	:	US
Telephone Number	:	843-523-5751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	09/05/2017

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Directions to “ GEORGE MOORE ” Practice Location

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