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NPI Code Detail

MEDICARE: EVERETT GERALD MOSS II CRNA

MEDICARE: EVERETT GERALD MOSS II CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC0200XCritical Care Medicine Registered Nurse247828GA
2367500000XCertified Registered Nurse Anesthetist27845SC

General Provider Information

NPI Number : 1477231066
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVERETT GERALD MOSS II CRNA
Provider Business Mailing Address
First Line : PO BOX 603484
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-3484
Country : US
Telephone Number : 803-765-1838
Fax Number : 803-765-1732
Provider Business Practice Location Address
First Line : 101 E WOOD ST
Second Line :
City : SPARTANBURG
State : SC
Zip : 29303-3040
Country : US
Telephone Number : 864-560-7571
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2023
Last Update Date : 05/22/2026

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