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204 Riverside Dr Moore OK 73160-1237 | |
| (405) 799-6900 | |
| (405) 799-6906 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 204 Riverside Dr, Moore, Oklahoma |
| Authorized Official Name and Position | Darius Noori (OWNER) |
| Authorized Official Contact | 4057592138 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
204 S. Riverside Drive Moore OK 73160 Ph: (405) 759-2138 | 204 Riverside Dr Moore OK 73160-1237 Ph: (405) 799-6900 |
| NPI Number | 1881882538 |
|---|---|
| Provider Enumeration Date | 10/09/2007 |
| Last Update Date | 05/31/2019 |
| Medicare PECOS PAC ID | 1951334044 |
|---|---|
| Medicare Enrollment ID | O20050919000455 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881882538 | NPI | - | NPPES |
| 200035170A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 21921 (Oklahoma) | Primary |
| Provider Name | Darius Noori |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053352872 PECOS PAC ID: 3779562194 Enrollment ID: I20040719000322 |
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