Basic Information
| Provider Information | |||||||||
| NPI: | 1427235449 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE MOORE CLINIC FOR WOMEN'S HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11001 EXECUTIVE CENTER DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722114316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018127800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1801 MARTIN LUTHER KING JR DR | ||||||||
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| City: | HELENA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723428998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703382727 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2008 | ||||||||
| LastUpdateDate: | 07/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | PITTMAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8703388778 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | E-5004 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 173015002 | 05 | AR | MEDICAID |