Moore Medical Clinic LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

16606 Issued in TN

Legal business name

MOORE MEDICAL CLINIC LLC

Practice address

600 Main St
Friendship, TN 38034-1999

Phone

(731) 677-3400

Fax

(731) 677-3402

NPI assigned

Apr 7, 2016

Organization subpart

No

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

Authorized official

Name

Phyllis Park Moore, DNP

Title

DNP/ Owner

Phone

(731) 617-1883

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Christian Family Medicine, LLC

  • Family Medicine Physician
  • Ripley, TN
  • NPI 1043252620

  Sold to, 2021-04-01

  CMS change of ownership

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

{
    "created_epoch": "1459987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459987200000",
    "number": "1801250667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 MAIN ST",
            "address_2": "P. O. BOX 41",
            "city": "FRIENDSHIP",
            "state": "TN",
            "postal_code": "380341999",
            "telephone_number": "731-677-3400",
            "fax_number": "731-677-3402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 MAIN ST",
            "city": "FRIENDSHIP",
            "state": "TN",
            "postal_code": "380341999",
            "telephone_number": "731-677-3400",
            "fax_number": "731-677-3402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORE MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-07",
        "last_updated": "2016-04-07",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "PARK",
        "authorized_official_title_or_position": "DNP/ OWNER",
        "authorized_official_telephone_number": "731-617-1883",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "16606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madelyne Ellis, FNP
• Hamilton York Haley, D.PH.
• Hamilton York Haley
• Madison Transport
• Mobile Healing LLC
• Phyllis P Moore, DNP,FNP-BC
• William Williams

• Family Nurse Practitioner in Friendship, TN
• Providers in Friendship, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.