Provider Demographics
NPI: | 1518444066 |
---|---|
Name: | LUMINIS HEALTH MEDICAL GROUP, LLC |
Entity Type: | Organization |
Organization Name: | LUMINIS HEALTH MEDICAL GROUP, LLC |
Other - Org Name: | AAMC'S WOMEN'S CENTER FOR PELVIC HEALTH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | REIMBURSEMENT ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JEANNETTE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WOOD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 443-481-6521 |
Mailing Address - Street 1: | 201 DEFENSE HWY STE 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | ANNAPOLIS |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21401-8902 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 443-481-5310 |
Mailing Address - Fax: | 443-481-6515 |
Practice Address - Street 1: | 505 DUTCHMANS LN |
Practice Address - Street 2: | |
Practice Address - City: | EASTON |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21601-4302 |
Practice Address - Country: | US |
Practice Address - Phone: | 443-481-1199 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-07-26 |
Last Update Date: | 2021-05-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 176B00000X | Other Service Providers | Midwife | Group - Multi-Specialty |