MEDICARE: BILL R MOSS

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1750052494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILL R MOSS

Provider Business Mailing Address
First Line	:	1609 N STRONG BLVD STE 500A
Second Line	:
City	:	MCALESTER
State	:	OK
Zip	:	74501-3839
Country	:	US
Telephone Number	:	918-715-3114
Fax Number	:	918-916-8004

Provider Business Practice Location Address
First Line	:	1609 N STRONG BLVD STE 500A
Second Line	:
City	:	MCALESTER
State	:	OK
Zip	:	74501-3839
Country	:	US
Telephone Number	:	918-715-3114
Fax Number	:	918-916-8004

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

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	09/22/2021

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Directions to “ BILL R MOSS ” Practice Location

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