Provider Demographics
NPI:1174159867
Name:MOONLIGHT TRANSPORTATION, INC.
Entity type:Organization
Organization Name:MOONLIGHT TRANSPORTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:YVES
Authorized Official - Middle Name:
Authorized Official - Last Name:TATAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-374-3883
Mailing Address - Street 1:6407 CROSSWINDS CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2922
Mailing Address - Country:US
Mailing Address - Phone:757-374-3883
Mailing Address - Fax:757-335-7673
Practice Address - Street 1:6407 CROSSWINDS CT
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2922
Practice Address - Country:US
Practice Address - Phone:757-374-3883
Practice Address - Fax:757-335-7673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)