| Name: | Moore Physician Services, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Series Limited Liability Company |
| Status: | Exists |
| Date of registration: | 18 Jan 2018 (7 years ago) (Companies founded in January 2018) |
| Entity Number: | 000-507-287 |
| Register Number: | 000507287 |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Registered Office Street Address: | 2 NORTH JACKSON ST. - SUITE 605MONTGOMERY, AL 36104 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336647098 | 2018-01-29 | 2022-03-23 | 200 CORPORATE BLVD, LAFAYETTE, LA, 705083870, US | 849 S THREE NOTCH ST, ANDALUSIA, AL, 364205325, US | |||||||||||||||||||||||||||||
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| Phone | +1 800-893-9698 |
| Phone | +1 334-222-8466 |
Authorized person
| Name | LISHA C FALK |
| Role | PE SUPERVISOR |
| Phone | 3376091221 |
Taxonomy
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | Yes |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 213027 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| FALK, LISHA | Organizer | 200 CORPORATE BLVDLAFAYETTE, LA 70508 |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
