Provider Demographics
NPI:1508037888
Name:MOON MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:MOON MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. PURCH. OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:OSADEBEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-905-9105
Mailing Address - Street 1:2730 N STEMMONS FWY BLDG STE215
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-2279
Mailing Address - Country:US
Mailing Address - Phone:214-905-9105
Mailing Address - Fax:214-634-3942
Practice Address - Street 1:2730 N STEMMONS FWY BLDG
Practice Address - Street 2:STE 215
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-2279
Practice Address - Country:US
Practice Address - Phone:214-905-9105
Practice Address - Fax:214-634-3942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0041165332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies