Organization
MACK MOORE SHOES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM M MOORE II CPED (GENERAL MANAGER)
(217) 345-3479
Entity
Organization
Contact information
Practice address
305 W LINCOLN AVE, CHARLESTON, IL 61920-3020
(217) 345-3479
(217) 345-7463
Mailing address
305 W LINCOLN AVE, CHARLESTON, IL 61920-3020
(217) 345-3479
(217) 345-7463
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
05/04/2007
Last updated
08/22/2020
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