1124095906 NPI number — DR. GEORGE T MOSES D.O.

Table of content: DR. GEORGE T MOSES D.O. (NPI 1124095906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124095906 NPI number — DR. GEORGE T MOSES D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSES
Provider First Name:
GEORGE
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124095906
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 HOSPITAL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-343-6631
Provider Business Mailing Address Fax Number:
330-343-8188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2845 BELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZANESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43701-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-454-9766
Provider Business Practice Location Address Fax Number:
740-588-6452
Provider Enumeration Date:
03/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  1563 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 15.63 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 34007515M , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000222218 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 300197600 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: Y544999 . This is a "HEALTH PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 260049831 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2205947 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 292576000 . This is a "MAGELLAN BEHAVIORAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311814468027 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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