MEDICARE: LUNA HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	231H00000X	Audiologist
2	237700000X	Hearing Instrument Specialist
3	237600000X	Audiologist-Hearing Aid Fitter

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003215005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUNA HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 350
Second Line	:
City	:	MAPLE VALLEY
State	:	WA
Zip	:	98038-0350
Country	:	US
Telephone Number	:	425-358-0956
Fax Number	:	877-481-6931

Provider Business Practice Location Address
First Line	:	1810 E COLLEGE WAY
Second Line	:	STE. 110
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-2362
Country	:	US
Telephone Number	:	360-336-5881
Fax Number	:	360-336-2323

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	JOHN LUNA
Credential	:
Telephone Number	:	425-358-0956

Provider Enumeration Date	:	08/15/2014
Last Update Date	:	08/01/2016

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Directions to “LUNA HEALTHCARE LLC ” Practice Location

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