Provider Demographics
NPI:1770697898
Name:LUNA U SY, MD, PC
Entity type:Organization
Organization Name:LUNA U SY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUNA
Authorized Official - Middle Name:U
Authorized Official - Last Name:SY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-445-9101
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36361-0190
Mailing Address - Country:US
Mailing Address - Phone:334-445-9101
Mailing Address - Fax:334-445-3501
Practice Address - Street 1:324 WHITE AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-0908
Practice Address - Country:US
Practice Address - Phone:334-445-9101
Practice Address - Fax:334-445-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529923920Medicaid
ALK398Medicare ID - Type UnspecifiedLUNA U SY, MD, PC