Healthcare Provider Details

I. General information

NPI: 1194825240
Provider Name (Legal Business Name): LUMINIS HEALTH IMAGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 N HANSON CT
BOWIE MD
20716-3179
US

IV. Provider business mailing address

PO BOX 404433
ATLANTA GA
30384-4433
US

V. Phone/Fax

Practice location:
  • Phone: 301-464-0798
  • Fax: 301-464-8410
Mailing address:
  • Phone: 804-756-5130
  • Fax: 804-672-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberNA
License Number State

VIII. Authorized Official

Name: MS. KAREN M SCOTT
Title or Position: VICE PRESIDENT
Credential:
Phone: 443-481-5335