1194825240 NPI number — LUMINIS HEALTH IMAGING, INC.

Table of content: (NPI 1194825240)

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:
ANNE ARUNDEL HEALTH CARE SERVICES,INC
Provider Other Organization Name Type Code:
4
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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