Provider Demographics
NPI:1982936456
Name:NEW MOON EXPRESS SERVICE CORP
Entity Type:Organization
Organization Name:NEW MOON EXPRESS SERVICE CORP
Other - Org Name:NEW MOON EXPRESS SERVICE CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:GLORIA
Authorized Official - Last Name:BERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-331-0151
Mailing Address - Street 1:1313 W POLK AVE STE 19
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-2141
Mailing Address - Country:US
Mailing Address - Phone:956-781-4600
Mailing Address - Fax:956-781-4678
Practice Address - Street 1:1313 W POLK AVE STE 19
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-2141
Practice Address - Country:US
Practice Address - Phone:956-781-4600
Practice Address - Fax:956-781-4678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6490520001Medicare NSC