MEDICARE: LUX CARE WELLNESS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1538056098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUX CARE WELLNESS LLC

Provider Business Mailing Address
First Line	:	2258 GUS THOMASSON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-3003
Country	:	US
Telephone Number	:	469-607-0787
Fax Number	:	469-607-0806

Provider Business Practice Location Address
First Line	:	2258 GUS THOMASSON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-3003
Country	:	US
Telephone Number	:	469-607-0787
Fax Number	:	469-607-0806

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ASGARD TORIZ
Credential	:
Telephone Number	:	469-238-3492

Provider Enumeration Date	:	06/18/2025
Last Update Date	:	06/18/2025

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