Moore Healthy Family Medical Clinic, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

MS18036 Issued in MS

Legal business name

MOORE HEALTHY FAMILY MEDICAL CLINIC, LLC

Practice address

5604 Old Canton Rd
Jackson, MS 39211-4217

Phone

(601) 991-1044

Fax

(601) 991-9868

NPI assigned

Nov 6, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert L Moore, MDNPI 1841281276

Title

Owner

Phone

(601) 307-2450

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert L Moore, M.D.

  • Family Medicine Physician
  • Jackson, MS
  • NPI 1841281276
  Medicare reassignment Authorized official
• Myranda Archie

  • Family Nurse Practitioner
  • Jackson, MS
  • NPI 1225872815
  NPD
• Stephanie L Moore, DIETITIAN

  • Registered Dietitian
  • Hattiesburg, MS
  • NPI 1760651947
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366243200000",
    "number": "1205137304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5604 OLD CANTON RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392114217",
            "telephone_number": "601-991-1044",
            "fax_number": "601-991-9868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5604 OLD CANTON RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392114217",
            "telephone_number": "601-991-1044",
            "fax_number": "601-991-9868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORE HEALTHY FAMILY MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-06",
        "last_updated": "2013-04-18",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-307-2450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": "MS18036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Lomax Montpelier
• Christopher Gunnar Moody, DO
• Laura Leigh C Moody, DMD
• Lorena Moody, PHARM. D.
• Richard Craig Mooney, RRT
• Sheena Moore-Carter, FNP
• Alan Rather Moore, MD
• Andrea Moore, FNP-BC
• Bridgett Moore
• Candice M. Moore, OTR L

• Primary Care Clinic/Center in Jackson, MS
• Providers in Jackson, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.