Basic Information
| Provider Information | |||||||||
| NPI: | 1710553219 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LUX HEALTHCARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 68 | ||||||||
| Address2: | |||||||||
| City: | OSCEOLA MILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166660068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143397101 | ||||||||
| FaxNumber: | 8143396165 | ||||||||
| Practice Location | |||||||||
| Address1: | 132 OLD RIVER RD | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028651161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143397101 | ||||||||
| FaxNumber: | 8143396165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2021 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | JAROJE | ||||||||
| AuthorizedOfficialFirstName: | KUMAIT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8143397101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.