Healthcare Provider Details

I. General information

NPI: 1699804757
Provider Name (Legal Business Name): MOSS HEARING AIDS, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N 6TH ST
QUINCY IL
62301-2904
US

IV. Provider business mailing address

114 N 6TH ST
QUINCY IL
62301-2904
US

V. Phone/Fax

Practice location:
  • Phone: 217-223-0204
  • Fax: 217-223-0274
Mailing address:
  • Phone: 217-223-0204
  • Fax: 217-223-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147000603
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number147000603
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number147000603
License Number StateIL

VIII. Authorized Official

Name: DR. ROBERT J MOSS
Title or Position: OWNER
Credential: AU.D.
Phone: 217-223-0204