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General NPI Number Information
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NPI Number | 1508037888
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Entity Type | Organization
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Legal Business Name | MOON MEDICAL SUPPLY, INC
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 2730 N STEMMONS FWY BLDG STE 215
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City | DALLAS
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State | TX
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Zip | 75207-2279
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Country | US
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Telephone | 214-905-9105
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Fax | 214-634-3942
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Provider Business Mailing Address
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Address Line | 2730 N STEMMONS FWY BLDG STE215
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City | DALLAS
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State | TX
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Zip | 75207-2279
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Country | US
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Telephone | 214-905-9105
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Fax | 214-634-3942
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Authorized Official
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Title or Position | ASST. PURCH. OFFICER
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Name | MR. EMMANUEL C OSADEBEY
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Credential |
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Telephone | 214-905-9105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0041165
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License Number State | TX
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