Provider Demographics
NPI:1801828389
Name:LU & WEBER CORPORATION
Entity type:Organization
Organization Name:LU & WEBER CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDERAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-672-0055
Mailing Address - Street 1:623 HIGHLAND COLONY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-6077
Mailing Address - Country:US
Mailing Address - Phone:714-643-8890
Mailing Address - Fax:714-643-8891
Practice Address - Street 1:10521 GARDEN GROVE BLVD BLDG 4
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1128
Practice Address - Country:US
Practice Address - Phone:714-643-8890
Practice Address - Fax:714-643-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA439860332B00000X, 332BP3500X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA439860Medicaid
CAZZZ364692OtherBLUE SHIELD
CA=========OtherBLUE CROSS
CA=========OtherUNITED HEALTHCARE INS CO
CAZZZ364692OtherBLUE SHIELD
CAPHA439860Medicaid