MEDICARE: COLLEEN F MOSS PA

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
1	363A00000X	Physician Assistant	917	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	009409	OTHER		KAISER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1528195500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN F MOSS PA

Provider Business Mailing Address
First Line	:	2240 E BUCHTELL BLVD
Second Line	:	#3 NORTH
City	:	DENVER
State	:	CO
Zip	:	80208-0001
Country	:	US
Telephone Number	:	303-871-6842
Fax Number	:	303-871-4242

Provider Business Practice Location Address
First Line	:	2240 E BUCHTELL BLVD
Second Line	:	#3 NORTH
City	:	DENVER
State	:	CO
Zip	:	80208-0001
Country	:	US
Telephone Number	:	303-871-6842
Fax Number	:	303-871-4242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	01/03/2012

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