Individual ProviderJacob MooreStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address4400 Emile St, Omaha, NE 68198-0600(402) 552-6007PECOS EnrollmentBased on the most recent information from CMS, provider Jacob Moore is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1679320634Provider TypeIndividualFull NameMoore, JacobTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date5/6/2024Last Updated5/6/2024Contact InformationPractice LocationPractice Address4400 Emile St, Omaha, NE 68198-0600Phone(402) 552-6007FaxUnlisted FaxMailing LocationMailing Address4400 Emile St, Omaha, NE 68198-0600PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerNebraska