1629031588 NPI number — LUNA MEDICAL, INC.

Table of content: (NPI 1629031588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629031588 NPI number — LUNA MEDICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUNA MEDICAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629031588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 E ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-1015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 S WELLS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60607-4529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-380-4339
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUH
Authorized Official First Name:
MARIANNE
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-380-4339

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1024415 . This is a "UNITED HEALTHCARE I.D." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1024415 . This is a "UNITED HEALTHCARE I.D." identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 01623767 . This is a "BCBS PROVIDER I.D." identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1024415 . This is a "UNITED HEALTHCARE I.D." identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1024415 . This is a "UNITED HEALTHCARE I.D." identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1024415 . This is a "UNITED HEALTHCARE I.D." identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1024415 . This is a "UNITED HEALTHCARE I.D." identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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