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Vicki C Moore

Social Worker

Behavioral Health & Social Service Providers

1565 Sainte Genevieve Ave, Farmington, MO 63640-3454

PECOS Enrollment

This provider is enrolled in PECOS as VICKI MOORE.

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

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

CMS last updated its PECOS records 34 days ago.

Profile Details

Provider ID
1649709809
Provider Type
Individual
Full Name
Moore, Vicki C
Credential
LCSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
6/9/2017
Last Updated
7/10/2023

Contact Information

Practice Location

1565 Sainte Genevieve Ave, Farmington, MO 63640-3454

(573) 756-5749

Unlisted Fax

Mailing Location

PO Box 459, Farmington, MO 63640-0459

(573) 756-5749

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 2017015119 Missouri

Vicki C Moore

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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