| Luminosity Integrated Rejuvenation | |
|
503 Depot Road Paintsville KY 41240 | |
| (606) 793-5077 | |
| Not Available |
| Full Name | Luminosity Integrated Rejuvenation |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 03/28/2024 |
| Last Update Date | 03/28/2024 |
| Certification Date | 03/26/2024 |
| Medicare PECOS PAC ID | 1153860366 |
|---|---|
| Medicare Enrollment ID | O20240830002075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073364170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (NU) | Primary |
| Provider Name | Jason Scott Short |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659813301 PECOS PAC ID: 9830471747 Enrollment ID: I20170127002045 |
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