Full Moon Medical Transportation LLC

Primary specialty

Transportation Network CompanyTaxonomy code 342000000X

Legal business name

FULL MOON MEDICAL TRANSPORTATION LLC

Practice address

11424 Old Mountain Rd
Glen Allen, VA 23060-1916

Phone

(804) 878-9000

NPI assigned

Apr 17, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wossen Belete

Title

Owner

Phone

(804) 878-9000

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682121600000",
    "number": "1639865249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11424 OLD MOUNTAIN RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230601916",
            "telephone_number": "804-878-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11424 OLD MOUNTAIN RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230601916",
            "telephone_number": "804-878-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL MOON MEDICAL TRANSPORTATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-17",
        "last_updated": "2023-04-22",
        "certification_date": "2023-04-22",
        "status": "A",
        "authorized_official_last_name": "BELETE",
        "authorized_official_first_name": "WOSSEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-878-9000"
    },
    "taxonomies": [
        {
            "code": "342000000X",
            "taxonomy_group": "",
            "desc": "Transportation Network Company",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janice Marie Frederick, HIS
• Allen Dale Freeman II, RPH
• Stefanie Froelich
• Caycee Frost, PA-C
• Emily W Frost, PMHNP-BC
• Kelli Funkhouser, MS, PT
• G Hagan Jackson MD PC
• Mona Gaafar
• Joseph Salo Galeski III, M.D.
• Jadig Garcia, PHD, LCP

• Transportation Network Company in Glen Allen, VA
• Providers in Glen Allen, VA by specialty
• Transportation Network Company in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.