1265474159 NPI number — DR. EDWARD L MOSLEY M.D.

Table of content: DR. EDWARD L MOSLEY M.D. (NPI 1265474159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265474159 NPI number — DR. EDWARD L MOSLEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSLEY
Provider First Name:
EDWARD
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1265474159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
980 HIGHWAY 28
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37347-3695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-942-8262
Provider Business Mailing Address Fax Number:
423-942-8292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
980 HIGHWAY 28
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37347-3695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-942-8262
Provider Business Practice Location Address Fax Number:
423-942-8292
Provider Enumeration Date:
06/12/2006

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: 207QG0300X , with the licence number:  0101238143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X , with the licence number: ME94903 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X , with the licence number: MD8257 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X , with the licence number: D0021954 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 0101238143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: ME94903 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: D0021954 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 0101238143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: ME94903 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: MD8257 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: D0021954 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: MD8257 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X , with the licence number: MD0000049564 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: MD0000049564 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: MD0000049564 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2754 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 6199 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0495776 . This is a "AETNA HEALTH MGMNT, LLC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112505 . This is a "AARP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8257207750000 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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