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LUMINIS HEALTH MEDICAL GROUP LLC NPI 1952564528


NPI Information

NPI: 1952564528
Provider Name: LUMINIS HEALTH MEDICAL GROUP, LLC

Doing Business As: CENTREVILLE FAMILY MEDICINE

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 21D1102815

Address:
202 COURSEVALL DR
CENTREVILLE, MD
ZIP 21617
Phone: (410) 758-3303
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LUMINIS HEALTH MEDICAL GROUP, LLC is a family medicine in Centreville, MD. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. LUMINIS HEALTH MEDICAL GROUP, LLC NPI is 1952564528. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Centreville Family Medicine.

The provider's business location address is:

202 COURSEVALL DR
CENTREVILLE, MD
ZIP 21617-804
Phone: (410) 758-3303
Fax: (410) 758-3310

The provider's authorized official is Peter Odenwald .
The authorized official title is Vp Business Development and has the following contact phone number (443) 481-6415.

The CLIA number assigned to this NPI record is 21D1102815 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/3/2008 and was last updated on 5/24/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineD35048MARYLANDYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1407175117MEDICAIDMARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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