Provider Demographics
NPI:1629031588
Name:LUNA MEDICAL, INC.
Entity Type:Organization
Organization Name:LUNA MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:LUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-380-4339
Mailing Address - Street 1:49 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 S WELLS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4529
Practice Address - Country:US
Practice Address - Phone:800-380-4339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1024415OtherUNITED HEALTHCARE I.D.
KY1024415OtherUNITED HEALTHCARE I.D.
IL01623767OtherBCBS PROVIDER I.D.
VA1024415OtherUNITED HEALTHCARE I.D.
GA1024415OtherUNITED HEALTHCARE I.D.
IN1024415OtherUNITED HEALTHCARE I.D.
IL1024415OtherUNITED HEALTHCARE I.D.
IL1024415OtherUNITED HEALTHCARE I.D.