Basic Information
| Provider Information | |||||||||
| NPI: | 1326088766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2151 OLD ROCKY RIDGE RD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352166101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059891080 | ||||||||
| FaxNumber: | 2059891087 | ||||||||
| Practice Location | |||||||||
| Address1: | 2621 19TH ST S | ||||||||
| Address2: | |||||||||
| City: | HOMEWOOD | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052718200 | ||||||||
| FaxNumber: | 2052718217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 08/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1-052404 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 515-32935 | 01 | AL | BLUECROSS BLUESHIELD AL | OTHER | P00297305 | 01 | AL | MED-RAILROAD | OTHER | 051557298 | 05 | AL | MEDICAID |