Healthcare Provider Details

I. General information

NPI: 1598676850
Provider Name (Legal Business Name): MOON MEDICAL TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 MCDIVITT ROAD APT 208
MADISON WI
53713
US

IV. Provider business mailing address

2809 E HAMILTON AVE # 143
EAU CLAIRE WI
54701-6863
US

V. Phone/Fax

Practice location:
  • Phone: 612-466-1024
  • Fax:
Mailing address:
  • Phone: 612-466-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ABDIRAHMAN ABDI ALI
Title or Position: OWNER
Credential:
Phone: 612-466-1024