Healthcare Provider Details

I. General information

NPI: 1861322497
Provider Name (Legal Business Name): MOSS HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 PAR DR
GILLETTE WY
82718-7623
US

IV. Provider business mailing address

619 PAR DR
GILLETTE WY
82718-7623
US

V. Phone/Fax

Practice location:
  • Phone: 423-620-8971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMBER MOSS
Title or Position: DR.
Credential: DO
Phone: 423-620-8971