Provider Demographics
NPI:1699804757
Name:MOSS HEARING AIDS, INCORPORATED
Entity type:Organization
Organization Name:MOSS HEARING AIDS, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:217-223-0204
Mailing Address - Street 1:114 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2904
Mailing Address - Country:US
Mailing Address - Phone:217-223-0204
Mailing Address - Fax:217-223-0274
Practice Address - Street 1:114 N 6TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2904
Practice Address - Country:US
Practice Address - Phone:217-223-0204
Practice Address - Fax:217-223-0274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000603231H00000X, 237600000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1528264447OtherINDIVIDUAL NPI #
IL00132059OtherBLUE CROSS/BLUE SHIELD OF IL
IL147000603OtherDEPT OF PROFESSIONAL REGU
IL324426333002Medicaid
IL=========6230101OtherIDHFS