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Riley Dale Moore

Student in an Organized Health Care Education/Training Program

Student, Health Care

19555 N 59th Ave, Glendale, AZ 85308-6813

PECOS Enrollment

This provider is enrolled in PECOS as RILEY MOORE.

Based on the most recent information from CMS, provider Riley Dale Moore is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 8 days ago.

Profile Details

Provider ID
1093590838
Provider Type
Individual
Full Name
Moore, Riley Dale
Gender
Male

Sole Proprietor
Yes
Enumeration Date
8/29/2023
Last Updated
8/29/2023

Contact Information

Practice Location

19555 N 59th Ave, Glendale, AZ 85308-6813

(623) 572-3200

Unlisted Fax

Mailing Location

6125 E Indian School Rd Apt 249, Scottsdale, AZ 85251-5496

(641) 590-6259

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 390200000X Primary	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Riley Dale Moore

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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Purewal, Karen Kaur

Edwards, Pamela (Pam) Ann

Moran, Paola Belen

Haong, Samantha

Rademaker, Marc

Kaluzny, Kaitlin

Maharaj, Kavir

Larson, Ross

Navarrete, Cristhian Adrian