Individual ProviderMarc R MoonThoracic Surgery (Cardiothoracic Vascular Surgery)Allopathic & Osteopathic PhysiciansPractice Address6770 Bertner Ave, Houston, TX 77030-2604(832) 355-3000(832) 355-9910PECOS EnrollmentThis provider is enrolled in PECOS as MARC MOON.Based on the most recent information from CMS, provider Marc R Moon is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1528086162Provider TypeIndividualFull NameMoon, Marc RTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date7/18/2006Last Updated11/21/2022Contact InformationPractice LocationPractice Address6770 Bertner Ave, Houston, TX 77030-2604Phone(832) 355-3000FaxUnlisted FaxMailing LocationMailing AddressOne Baylor Plaza, Ms: Bcm390, Houston, TX 77030Phone(832) 355-9910Fax(832) 355-9920Provider TaxonomiesCodeDescriptionLicenseCode208G00000XPrimaryDescriptionThoracic Surgery (Cardiothoracic Vascular Surgery)Allopathic & Osteopathic PhysiciansLicense47499TexasCode208G00000XDescriptionThoracic Surgery (Cardiothoracic Vascular Surgery)Allopathic & Osteopathic PhysiciansLicense115539MissouriProvider IdentifiersIDDescriptionIssuerID203784509DescriptionMedicaidIssuerUnlistedMissouri