MEDICARE: MOONSTAR TRANSPORTATION LLC

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	251C00000X	Developmentally Disabled Services Day Training Agency	2547275	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972813194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOONSTAR TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	6161 BUSCH BLVD STE 313
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2555
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6161 BUSCH BLVD STE 313
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2555
Country	:	US
Telephone Number	:	614-947-1381
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DIRIYE ALI
Credential	:
Telephone Number	:	614-260-6617

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	10/21/2010

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Directions to “MOONSTAR TRANSPORTATION LLC ” Practice Location

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