Provider Demographics
NPI:1952683526
Name:LUNA MEDICINE
Entity Type:Organization
Organization Name:LUNA MEDICINE
Other - Org Name:AUSTIN WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-473-8900
Mailing Address - Street 1:1700 S LAMAR BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8962
Mailing Address - Country:US
Mailing Address - Phone:512-473-8900
Mailing Address - Fax:512-472-9898
Practice Address - Street 1:1700 S LAMAR BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8962
Practice Address - Country:US
Practice Address - Phone:512-473-8900
Practice Address - Fax:512-472-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9520208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty