Provider Demographics
NPI:1003522798
Name:LUMINOSITY H&W LLC
Entity Type:Organization
Organization Name:LUMINOSITY H&W LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:STIBBENS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:719-321-4637
Mailing Address - Street 1:6455 N UNION BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5852
Mailing Address - Country:US
Mailing Address - Phone:719-301-7246
Mailing Address - Fax:
Practice Address - Street 1:6455 N UNION BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5852
Practice Address - Country:US
Practice Address - Phone:719-301-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty