| Luminox Healthcare Services Llc | |
|
4001 Pendennis Ct Upper Marlboro MD 20772-8304 | |
| (240) 553-7970 | |
| (347) 588-2943 |
| Full Name | Luminox Healthcare Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4001 Pendennis Ct, Upper Marlboro, Maryland |
| Authorized Official Name and Position | Olayemi Adurota (PRESIDENT) |
| Authorized Official Contact | 2408259529 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Luminox Healthcare Services Llc 4001 Pendennis Ct Upper Marlboro MD 20772-8304 Ph: (240) 553-7970 | Luminox Healthcare Services Llc 4001 Pendennis Ct Upper Marlboro MD 20772-8304 Ph: (240) 553-7970 |
| NPI Number | 1518669688 |
|---|---|
| Provider Enumeration Date | 03/21/2023 |
| Last Update Date | 03/21/2023 |
| Certification Date | 03/21/2023 |
| Medicare PECOS PAC ID | 7315312394 |
|---|---|
| Medicare Enrollment ID | O20230404002505 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518669688 | NPI | - | NPPES |
| Provider Name | Olayemi A Adurota |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437524899 PECOS PAC ID: 3971801515 Enrollment ID: I20160414000378 |
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