1194825240 NPI number — LUMINIS HEALTH IMAGING, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194825240 NPI number — LUMINIS HEALTH IMAGING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUMINIS HEALTH IMAGING, 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:
6
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:
1194825240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 404433
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-4433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-756-5130
Provider Business Mailing Address Fax Number:
804-672-6899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4175 N HANSON CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20716-3179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-464-0798
Provider Business Practice Location Address Fax Number:
301-464-8410
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
443-481-5335

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X , with the licence number: NA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 764801410 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: G01780 . This is a "MEDICARE GROUP DC LOCAL" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1073 . This is a "CAREFIRST DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: CK4885 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S645AN . This is a "CAREFIRST MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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