Provider Demographics
NPI:1932348281
Name:MOON ORTHOPEDICS
Entity Type:Organization
Organization Name:MOON ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:504-391-9141
Mailing Address - Street 1:3634 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2554
Mailing Address - Country:US
Mailing Address - Phone:504-267-5276
Mailing Address - Fax:504-391-0124
Practice Address - Street 1:3634 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2554
Practice Address - Country:US
Practice Address - Phone:504-267-5276
Practice Address - Fax:504-391-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
LA149623335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1974323Medicaid
LA1974323Medicaid