Organization
NEW MOON MEDICAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEN WORTHINGTON (PRESIDENT)
(859) 737-5154
Entity
Organization
Contact information
Practice address
1210 W LEXINGTON AVE, SUITE B, WINCHESTER, KY 40391-1127
(859) 737-5154
(877) 737-1881
Mailing address
PO BOX 331, WINCHESTER, KY 40392-0331
(859) 737-5154
(877) 737-1881
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
184257
KY
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1865915
HIGHMARK BLUE SHIELD
KY
01
—
393322
ANTHEM PROVIDER #
KY
01
—
7436866
AETNA PIN #
KY
05
—
90012758
—
KY
01
—
D 5624460001
UNITED AMERICAN INSURANCE
KY
Enumeration date
12/21/2006
Last updated
06/13/2012
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