Provider Demographics
NPI:1962864603
Name:LUMIN ER GRANBURY
Entity Type:Organization
Organization Name:LUMIN ER GRANBURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:VANHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-972-4976
Mailing Address - Street 1:3801 E US HIGHWAY 377
Mailing Address - Street 2:STE 100
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-7429
Mailing Address - Country:US
Mailing Address - Phone:913-972-4976
Mailing Address - Fax:
Practice Address - Street 1:3801 E US HIGHWAY 377
Practice Address - Street 2:STE 100
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-7429
Practice Address - Country:US
Practice Address - Phone:913-972-4976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care