Provider Demographics
NPI:1104621358
Name:LUXMED LLC
Entity type:Organization
Organization Name:LUXMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BRANCATI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-283-9801
Mailing Address - Street 1:30 N GOULD ST STE N
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6317
Mailing Address - Country:US
Mailing Address - Phone:419-283-9801
Mailing Address - Fax:
Practice Address - Street 1:15 BRENDAN WAY STE 210
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3562
Practice Address - Country:US
Practice Address - Phone:864-305-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty