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Individual

JEREMIAH JOHN MOSS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1409 16TH STREET, HOXIE, KS 67740
(785) 657-1411
Mailing address
1409 16TH STREET, PO BOX 311, HOXIE, KS 67740
(785) 657-1411

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-02422
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
XSB898139036
BLUE CROSS BLUE SHIELD
KS
Enumeration date
10/09/2015
Last updated
10/09/2015
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