Ilumina Life Center, P.C.

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

MD423112 Issued in PA

Legal business name

ILUMINA LIFE CENTER, P.C.

Practice address

418 N Logan Blvd
Suite B
Burnham, PA 17009-1816

Phone

(717) 242-3900

Fax

(717) 248-8590

NPI assigned

Aug 4, 2015

Last updated

Aug 4, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Melody Cooper

Title

Ceo

Phone

(814) 467-4055

Specialties & licenses 1

Addresses

Tax ID family

Ilumina Life Center PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ilumina Life Center, P.C.

  • Pain Medicine (Anesthesiology) Physician
  • Johnstown, PA
  • NPI 1295101715
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph F. Marra Jr., CRNP

  • Family Nurse Practitioner
  • Clayton, NM
  • NPI 1235190596
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438646400000",
    "number": "1942686753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 JAYCEE DR",
            "address_2": "SUITE 10",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159043650",
            "telephone_number": "814-467-4055",
            "fax_number": "814-262-8161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 N LOGAN BLVD",
            "address_2": "SUITE B",
            "city": "BURNHAM",
            "state": "PA",
            "postal_code": "170091816",
            "telephone_number": "717-242-3900",
            "fax_number": "717-248-8590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILUMINA LIFE CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-04",
        "last_updated": "2015-08-04",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "MELODY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "814-467-4055"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "PA",
            "license": "MD423112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rebecca Lynn Kruise, M.S. CCC-SLP
• Jacob Lenhart
• Tori K Lesko, LMSW

• Interventional Pain Medicine Physician in Burnham, PA
• Providers in Burnham, PA by specialty
• Interventional Pain Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.