Organization
SOUTH MOORE MEDICAL CLINIC, PC
Active
Other names
South Moore Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH R LAYNE D.O. (OWNER)
(405) 912-4900
Entity
Organization
Contact information
Practice address
14800 S WESTERN AVE, MOORE, OK 73170-7112
(405) 912-4900
(405) 912-4903
Mailing address
14800 S WESTERN AVE, OKLAHOMA CITY, OK 73170-7112
(405) 912-4900
(405) 912-4903
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
560202001
DME NUMBER
OK
Enumeration date
10/06/2006
Last updated
03/18/2011
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