Healthcare Provider Details

I. General information

NPI: 1164692505
Provider Name (Legal Business Name): STEVEN N MOY BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E MAIN ST SUITE 108
ANOKA MN
55303-1771
US

IV. Provider business mailing address

222 E MAIN ST SUITE 108
ANOKA MN
55303-1771
US

V. Phone/Fax

Practice location:
  • Phone: 763-421-4234
  • Fax: 763-421-2135
Mailing address:
  • Phone: 763-421-4234
  • Fax: 763-421-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2316
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: