MR. JACOB WAYNE MOSS M.D. J.D. NPI 1205179751

NPI Information

NPI: 1205179751
Provider Name: MR. JACOB WAYNE MOSS, M.D., J.D.
Classification: General Practice - 208D00000X
Entity Type: Individual
Organization: AMERIHEALTH INC

PECOS Registration: Yes

Address:
1995 E 17TH ST
IDAHO FALLS, ID
ZIP 83404
Phone: (208) 538-1999
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MR. Jacob Wayne Moss, M.D., J.D. is a general practice in Idaho Falls, ID with 11 years of experience. MR. Jacob Wayne Moss, M.D., J.D. NPI is 1205179751. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2013

The provider's business location address is:

1995 E 17TH ST
IDAHO FALLS, ID
ZIP 83404-493
Phone: (208) 538-1999
Fax: (208) 881-5295

The NPI 1205179751 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/3/2013 and was last updated on 2/17/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	390200000X	Student in an Organized Health Care Education/Training Program				No
2	208D00000X	General Practice		M-14547	IDAHO	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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