MEDICARE: LUNA MEDICAL, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1024415	OTHER	FL	UNITED HEALTHCARE I.D.
2	1024415	OTHER	KY	UNITED HEALTHCARE I.D.
3	01623767	OTHER	IL	BCBS PROVIDER I.D.
4	1024415	OTHER	VA	UNITED HEALTHCARE I.D.
5	1024415	OTHER	GA	UNITED HEALTHCARE I.D.
6	1024415	OTHER	IN	UNITED HEALTHCARE I.D.
7	1024415	OTHER	IL	UNITED HEALTHCARE I.D.

General Provider Information

NPI Number	:	1629031588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUNA MEDICAL, INC.

Provider Business Mailing Address
First Line	:	49 E ELM ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-1015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 S WELLS ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4529
Country	:	US
Telephone Number	:	800-380-4339
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARIANNE H. LUH
Credential	:
Telephone Number	:	800-380-4339

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	08/22/2020

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