Provider Demographics
NPI:1871082164
Name:THE MOORE CENTER PC
Entity type:Organization
Organization Name:THE MOORE CENTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INSURANCE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-731-8846
Mailing Address - Street 1:PO BOX 561483
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-1483
Mailing Address - Country:US
Mailing Address - Phone:877-825-8589
Mailing Address - Fax:720-859-3474
Practice Address - Street 1:901 BOREN AVE
Practice Address - Street 2:SUITE #1800
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-971-2266
Practice Address - Fax:425-880-5817
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MOORE CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-02
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X, 261QM0850X, 261QM0855X
WA200531261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health