Provider Demographics
NPI:1023299328
Name:MOON ORTHOPEDICS
Entity type:Organization
Organization Name:MOON ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:P
Authorized Official - Last Name:RICHOUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-391-9141
Mailing Address - Street 1:139 BELLEMEADE BLVD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7108
Mailing Address - Country:US
Mailing Address - Phone:504-391-9141
Mailing Address - Fax:504-391-0124
Practice Address - Street 1:139 BELLEMEADE BLVD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7108
Practice Address - Country:US
Practice Address - Phone:504-391-9141
Practice Address - Fax:504-391-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1974323Medicaid
LA0598250001Medicare NSC