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Individual

CHARLES MOONEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
2513 LAZY BROOK LN, LAWRENCE, KS 66047-2446
(785) 691-8645
(866) 358-7460
Mailing address
2513 LAZY BROOK LN, LAWRENCE, KS 66047-2446
(785) 691-8645
(866) 358-7460

Taxonomy

Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
467
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
46-122411
TRANSPORTATION PRIVIDER
KS
Enumeration date
02/27/2014
Last updated
02/27/2014
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