Edward L Mosley, M.D.
Individual provider Active NPI Surgery Physician · Jasper, TN
NPI 1265474159 · NPPES record last updated Dec 19, 2007
Key facts
- NPI
- 1265474159
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- MD0000049564 (TN)
- Practice address
- 980 Highway 28
Suite 203
Jasper, TN 37347-3695 - Phone
- (423) 942-8262
- Fax
- (423) 942-8292
- NPI assigned
- Jun 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD8257 | DC | MD | Geriatric Medicine (Family Medicine) Physician |
| ME94903 | FL | MD | Geriatric Medicine (Family Medicine) Physician |
| D0021954 | MD | MD | Surgery Physician |
| MD0000049564 | TN | MD | Surgery Physician |
| 0101238143 | VA | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Wound Systems LLC | Past | Accepting new patients | |
| National Healing Community Wound Care, LLC | Surgery | Past | Accepting new patients |
| Nautilus Health Care Group, LLC | Past | Accepting new patients | |
| Edward L Mosley Jr | Surgery | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | 0101238143 | VA | |
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | ME94903 | FL | |
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | MD8257 | DC | |
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | D0021954 | MD | |
| Surgery Physician | 208600000X | 0101238143 | VA | |
| Surgery Physician | 208600000X | ME94903 | FL | |
| Surgery Physician | 208600000X | D0021954 | MD | |
| General Practice Physician | 208D00000X | 0101238143 | VA | |
| General Practice Physician | 208D00000X | ME94903 | FL | |
| General Practice Physician | 208D00000X | MD8257 | DC | |
| General Practice Physician | 208D00000X | D0021954 | MD | |
| Surgery Physician | 208600000X | MD8257 | DC | |
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | MD0000049564 | TN | |
| Surgery Physician | 208600000X | MD0000049564 | TN | Yes |
| General Practice Physician | 208D00000X | MD0000049564 | TN |
Addresses
Primary practice location
980 Highway 28
Suite 203
Jasper, TN 37347-3695
Mailing address
980 Highway 28
Suite 203
Jasper, TN 37347-3695
Phone (423) 942-8262
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2754 | Other | DC | BLUE CROSS BLUE SHIELD |
| 6199 | Other | MD | BLUE CROSS BLUE SHIELD |
| 0495776 | Other | AETNA HEALTH MGMNT, LLC | |
| 112505 | Other | AARP | |
| 8257207750000 | Other | TRICARE |
Other providers in Jasper, TN
- Jana Marlow
- Medical Arts Plaza, P.C.
- Medical Equipment Distributors of Tenessee
- Paul A Miranda
- Isabelle Moore
- Northland Hearing Center, Inc.
- Oxygen Plus, Corp
- Hal Jamison Parker
- James Aulton Parker
- Parkridge Medical Center, Inc.
All providers in Jasper, TN · Surgery Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.