1730136532 NPI number — LUMINIS HEALTH DOCTORS COMMUNITY MEDICAL CENTER, 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 1730136532 NPI number — LUMINIS HEALTH DOCTORS COMMUNITY MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUMINIS HEALTH DOCTORS COMMUNITY MEDICAL CENTER, 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:
DOCTORS COMMUNITY HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1730136532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8118 GOOD LUCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANHAM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20706-3595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-552-0044
Provider Business Mailing Address Fax Number:
301-552-8181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8118 GOOD LUCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20706-3595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-552-0044
Provider Business Practice Location Address Fax Number:
301-552-8181
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HANSCOME
Authorized Official First Name:
JOYCE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
301-552-8176

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  16-022 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01005101 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 58052601 . This is a "BLUE CROSS - MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 068885100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 735 . This is a "BLUE CROSS - DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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