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General NPI Number Information
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NPI Number | 1154068484
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Entity Type | Organization
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Legal Business Name | LUNATE 66 LLC
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 3150 HIGHWAY 153
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City | PIEDMONT
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State | SC
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Zip | 29673-9498
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Country | US
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Telephone | 864-740-5301
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Fax | 864-740-5302
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Provider Business Mailing Address
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Address Line | 3150 HIGHWAY 153
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City | PIEDMONT
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State | SC
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Zip | 29673-9498
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Country | US
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Telephone | 864-740-5301
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Fax | 864-740-5302
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | DONNA DUFFIE
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Credential |
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Telephone | 864-740-5301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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