Provider Demographics
NPI:1710553219
Name:LUX HEALTHCARE LLC
Entity Type:Organization
Organization Name:LUX HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KUMAIT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAROJE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-339-7101
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:16666-0068
Mailing Address - Country:US
Mailing Address - Phone:814-339-7101
Mailing Address - Fax:814-339-6165
Practice Address - Street 1:132 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1161
Practice Address - Country:US
Practice Address - Phone:814-339-7101
Practice Address - Fax:814-339-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty