Healthcare Provider Details

I. General information

NPI: 1952233025
Provider Name (Legal Business Name): MOSS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 E BOXELDER RD STE L
GILLETTE WY
82718-5582
US

IV. Provider business mailing address

619 PAR DR
GILLETTE WY
82718-7623
US

V. Phone/Fax

Practice location:
  • Phone: 307-298-7213
  • Fax:
Mailing address:
  • Phone: 423-620-8971
  • 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: OWNER
Credential: DO
Phone: 423-620-8971