Provider Demographics
NPI:1346053907
Name:LUMEN WELLNESS INC
Entity type:Organization
Organization Name:LUMEN WELLNESS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-453-5999
Mailing Address - Street 1:2931 MONTE VISTA BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2165
Mailing Address - Country:US
Mailing Address - Phone:505-205-1475
Mailing Address - Fax:
Practice Address - Street 1:2931 MONTE VISTA BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2165
Practice Address - Country:US
Practice Address - Phone:505-205-1475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy