MEDICARE: MOON MEDICAL CENTER

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1902722036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOON MEDICAL CENTER

Provider Business Mailing Address
First Line	:	2501 CHATHAM RD STE 6341
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4188
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 BALCONES DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4257
Country	:	US
Telephone Number	:	423-243-2424
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KYLE DENNIS
Credential	:
Telephone Number	:	423-243-1578

Provider Enumeration Date	:	06/24/2026
Last Update Date	:	06/24/2026

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Directions to “MOON MEDICAL CENTER ” Practice Location

Language	Start Address	Practice Location

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