MEDICARE: JAMES MOSS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363L00000X	Nurse Practitioner
2	363AM0700X	Medical Physician Assistant
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1932492733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES MOSS PLLC

Provider Business Mailing Address
First Line	:	1105 JULIANNA CT
Second Line	:	SUITE 1
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-7937
Country	:	US
Telephone Number	:	270-763-0030
Fax Number	:	270-763-0050

Provider Business Practice Location Address
First Line	:	1105 JULIANNA CT
Second Line	:	SUITE 1
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-7937
Country	:	US
Telephone Number	:	270-763-0030
Fax Number	:	270-763-0050

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES MOSS
Credential	:	M.D.
Telephone Number	:	502-244-0923

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	12/05/2011

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