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General NPI Number Information
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NPI Number | 1962486829
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Entity Type | Individual
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Provider Name | CHARLES JOSEPH MOSS III CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 715 N WEBER ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-1091
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Country | US
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Telephone | 719-473-6115
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Fax | 719-472-2577
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Provider Business Mailing Address
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Address Line | 2 S CASCADE AVE STE 140
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-1604
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Country | US
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Telephone | 719-866-6568
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Fax | 719-538-2999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 21451
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA0841
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APN.0992028-CRNA
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License Number State | CO
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