Organization
MOOSALLY MEDICAL
Active
Parent organization
COWFISH INDUSTRIES LLC
Other names
Moosally Medical
Organization subpart
Yes
Provider details
NPI number
Legal business name
COWFISH INDUSTRIES LLC
Authorized official
DR. ROBERT MOOSALLY JR. DO (OWNER/PHYSICIAN)
(330) 460-5514
Entity
Organization
Contact information
Practice address
2537 E MARKET ST, WARREN, OH 44483-6257
(330) 460-5514
(330) 595-4366
Mailing address
8905 SOUTH ST SE, WARREN, OH 44484-2357
(330) 402-3443
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
374989
—
OH
Enumeration date
12/14/2022
Last updated
12/14/2022
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