Active NPI
Jack Ellis Moseley Jr., M.D.
- Internal Medicine Physician
- Enid, OK
National Provider Identifier
1558438887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 20477
- Practice address
- 2600 E Willow Rd
Northern Oklahoma Resource Center
Enid, OK 73701-8715 - Phone
- (580) 213-2700
- Fax
- (580) 548-2647
- NPI assigned
- Nov 30, 2006
- Last updated
- Aug 26, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 20477 | OK | Primary |
| Pediatrics Physician | 208000000X | 20477 | OK |
Addresses
Primary practice location
2600 E Willow Rd
Northern Oklahoma Resource Center
Enid, OK 73701-8715
Mailing address
2600 E. Willow
Northern Oklahoma Resource Center
Enid, OK 73701-8715
Phone (580) 213-2700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20477 | OK | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northern Oklahoma Resource Center of Enid | Past | Accepting new patients | |
| Northern Oklahoma Resource Center of Enid Pharmacy | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Enid, OK
- NPI 1649388711
-
dba Norce Pharmacy
- Long Term Care Pharmacy
- Enid, OK
- NPI 1790889038
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251244800000",
"number": "1558438887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 E. WILLOW",
"address_2": "NORTHERN OKLAHOMA RESOURCE CENTER",
"city": "ENID",
"state": "OK",
"postal_code": "737018715",
"telephone_number": "580-213-2700",
"fax_number": "580-548-2647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 E WILLOW RD",
"address_2": "NORTHERN OKLAHOMA RESOURCE CENTER",
"city": "ENID",
"state": "OK",
"postal_code": "737018715",
"telephone_number": "580-213-2700",
"fax_number": "580-548-2647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSELEY",
"first_name": "JACK",
"middle_name": "ELLIS",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-30",
"last_updated": "2009-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OK",
"license": "20477",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OK",
"license": "20477",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Enid, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.