NPIMap

Organization Active NPI

South Moore Medical Clinic, PC

  • Durable Medical Equipment & Medical Supplies
  • Moore, OK
National Provider Identifier
1912094244
Registry record updated Mar 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
SOUTH MOORE MEDICAL CLINIC, PC
Doing business as
South Moore Medical Clinic
Practice address
14800 S Western Ave
Moore, OK 73170-7112
Phone
(405) 912-4900
Fax
(405) 912-4903
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2011

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

Authorized official

Name
Keith R Layne, D.O.NPI 1407843212
Title
Owner
Phone
(405) 912-4900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

14800 S Western Ave
Moore, OK 73170-7112

Mailing address

14800 S Western Ave
Oklahoma City, OK 73170-7112
Phone (405) 912-4900

Other identifiers 1

IdentifierTypeStateIssuer
560202001OtherOKDME NUMBER

Other names 1

  • South Moore Medical Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

14800 S Western Ave
Oklahoma City, OK 73170
Phone (405) 912-4900

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300406400000",
    "number": "1912094244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14800 S WESTERN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731707112",
            "telephone_number": "405-912-4900",
            "fax_number": "405-912-4903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14800 S WESTERN AVE",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731707112",
            "telephone_number": "405-912-4900",
            "fax_number": "405-912-4903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MOORE MEDICAL CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2011-03-18",
        "status": "A",
        "authorized_official_last_name": "LAYNE",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-912-4900",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME NUMBER",
            "identifier": "560202001",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Moore Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moore, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.