Provider Demographics
NPI:1669640660
Name:NORMAN W MOSS MD, INC PS
Entity Type:Organization
Organization Name:NORMAN W MOSS MD, INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-469-1903
Mailing Address - Street 1:215 S 11TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3253
Mailing Address - Country:US
Mailing Address - Phone:509-248-6192
Mailing Address - Fax:
Practice Address - Street 1:215 S 11TH AVE STE D
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3253
Practice Address - Country:US
Practice Address - Phone:509-248-6192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00008347207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACJ3618OtherRAILROAD MEDICARE PIN
WA7107857Medicaid
WA7107857Medicaid