Basic Information
| Provider Information | |||||||||
| NPI: | 1164877148 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSS | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | AMANDA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPARTMENT OF EMERGENCY MEDICINE 1313 21 ST AVE S | ||||||||
| Address2: | 703 OXFORD HOUSE | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372324700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159360087 | ||||||||
| FaxNumber: | 6159361316 | ||||||||
| Practice Location | |||||||||
| Address1: | DEPARTMENT OF EMERGENCY MEDICINE 1313 21 ST AVE S | ||||||||
| Address2: | 703 OXFORD HOUSE | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372324700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159360087 | ||||||||
| FaxNumber: | 6159361316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2016 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 58032 | AZ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 529066 | 05 | AZ | MEDICAID |