MEDICARE: MOON MEDICAL SUPPLY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	0041165	TX

General Provider Information

NPI Number	:	1508037888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOON MEDICAL SUPPLY, INC

Provider Business Mailing Address
First Line	:	2730 N STEMMONS FWY BLDG STE215
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75207-2279
Country	:	US
Telephone Number	:	214-905-9105
Fax Number	:	214-634-3942

Provider Business Practice Location Address
First Line	:	2730 N STEMMONS FWY BLDG
Second Line	:	STE 215
City	:	DALLAS
State	:	TX
Zip	:	75207-2279
Country	:	US
Telephone Number	:	214-905-9105
Fax Number	:	214-634-3942

Authorized Official
Title or Position	:	ASST. PURCH. OFFICER
Name	:	MR. EMMANUEL C OSADEBEY
Credential	:
Telephone Number	:	214-905-9105

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	03/14/2008

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