Healthcare Provider Details

I. General information

NPI: 1104621358
Provider Name (Legal Business Name): LUXMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BRENDAN WAY STE 210
GREENVILLE SC
29615-3562
US

IV. Provider business mailing address

30 N GOULD ST STE N
SHERIDAN WY
82801-6317
US

V. Phone/Fax

Practice location:
  • Phone: 864-305-5000
  • Fax:
Mailing address:
  • Phone: 419-283-9801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID SCOTT BRANCATI
Title or Position: MEMBER
Credential: DO
Phone: 419-283-9801