Luminosity Integrated Rejuvenation | |
503 Depot Road Paintsville KY 41240 | |
(606) 793-5077 | |
Not Available |
Full Name | Luminosity Integrated Rejuvenation |
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Speciality | Clinic/Center |
Location | 503 Depot Road, Paintsville, Kentucky |
Authorized Official Name and Position | Jason Short (OWNER) |
Authorized Official Contact | 6067935077 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Luminosity Integrated Rejuvenation Po Box 55 Staffordsville KY 41256-0055 Ph: (606) 793-5077 | Luminosity Integrated Rejuvenation 503 Depot Road Paintsville KY 41240 Ph: (606) 793-5077 |
NPI Number | 1073364170 |
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Provider Enumeration Date | 03/28/2024 |
Last Update Date | 03/28/2024 |
Medicare PECOS PAC ID | 1153860366 |
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Medicare Enrollment ID | O20240830002075 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073364170 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Jason Scott Short |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659813301 PECOS PAC ID: 9830471747 Enrollment ID: I20170127002045 |
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