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General NPI Number Information
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NPI Number | 1093879009
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Entity Type | Organization
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Legal Business Name | NEW MOON MEDICAL, INC
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 1210 W LEXINGTON AVE SUITE B
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City | WINCHESTER
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State | KY
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Zip | 40391-1127
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Country | US
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Telephone | 859-737-5154
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Fax | 877-737-1881
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Provider Business Mailing Address
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Address Line | PO BOX 331
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City | WINCHESTER
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State | KY
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Zip | 40392-0331
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Country | US
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Telephone | 859-737-5154
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Fax | 877-737-1881
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Authorized Official
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Title or Position | PRESIDENT
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Name | BEN WORTHINGTON
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Credential |
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Telephone | 859-737-5154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 184257
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License Number State | KY
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