Provider Demographics
NPI:1093248924
Name:LUX AESTHETIC MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:LUX AESTHETIC MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:844-589-7233
Mailing Address - Street 1:PO BOX 1169
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-1169
Mailing Address - Country:US
Mailing Address - Phone:844-589-7233
Mailing Address - Fax:877-457-8231
Practice Address - Street 1:530 S WACO ST
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-7110
Practice Address - Country:US
Practice Address - Phone:844-589-7233
Practice Address - Fax:877-457-8231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty