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General NPI Number Information
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NPI Number | 1104621358
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Entity Type | Organization
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Legal Business Name | LUXMED LLC
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 15 BRENDAN WAY STE 210
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City | GREENVILLE
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State | SC
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Zip | 29615-3562
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Country | US
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Telephone | 864-305-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N GOULD ST STE N
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City | SHERIDAN
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State | WY
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Zip | 82801-6317
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Country | US
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Telephone | 419-283-9801
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DAVID SCOTT BRANCATI
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Credential | DO
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Telephone | 419-283-9801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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