1033508114 NPI number — LUMINIS HEALTH PATHWAYS, INC.

Table of content: (NPI 1033508114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033508114 NPI number — LUMINIS HEALTH PATHWAYS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUMINIS HEALTH PATHWAYS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033508114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64725
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-4725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-573-5454
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2620 RIVA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-7305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-573-5454
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
REINES
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
410-573-5454

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  903106 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3245S0500X , with the licence number: 903106 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 218240 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 58127901 . This is a "CAREFIRST OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: HB6 . This is a "CAREFIRST OF DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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