Provider Demographics
NPI:1932492733
Name:JAMES MOSS PLLC
Entity Type:Organization
Organization Name:JAMES MOSS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-244-0923
Mailing Address - Street 1:1105 JULIANNA CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7937
Mailing Address - Country:US
Mailing Address - Phone:270-763-0030
Mailing Address - Fax:270-763-0050
Practice Address - Street 1:1105 JULIANNA CT
Practice Address - Street 2:SUITE 1
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7937
Practice Address - Country:US
Practice Address - Phone:270-763-0030
Practice Address - Fax:270-763-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK005250Medicare PIN