<?xml version="1.0"?>
<ownershipDocument>

    <schemaVersion>X0508</schemaVersion>

    <documentType>4</documentType>

    <periodOfReport>2025-12-12</periodOfReport>

    <issuer>
        <issuerCik>0002071288</issuerCik>
        <issuerName>Lumexa Imaging Holdings, Inc.</issuerName>
        <issuerTradingSymbol>LMRI</issuerTradingSymbol>
    </issuer>

    <reportingOwner>
        <reportingOwnerId>
            <rptOwnerCik>0002102971</rptOwnerCik>
            <rptOwnerName>Walker James Edward Jr.</rptOwnerName>
        </reportingOwnerId>
        <reportingOwnerAddress>
            <rptOwnerStreet1>4200 SIX FORKS ROAD</rptOwnerStreet1>
            <rptOwnerStreet2>SUITE 1000</rptOwnerStreet2>
            <rptOwnerCity>RALEIGH</rptOwnerCity>
            <rptOwnerState>NC</rptOwnerState>
            <rptOwnerZipCode>27609</rptOwnerZipCode>
            <rptOwnerStateDescription></rptOwnerStateDescription>
        </reportingOwnerAddress>
        <reportingOwnerRelationship>
            <isOfficer>true</isOfficer>
            <officerTitle>Principal Accounting Officer</officerTitle>
        </reportingOwnerRelationship>
    </reportingOwner>

    <aff10b5One>false</aff10b5One>

    <nonDerivativeTable>
        <nonDerivativeTransaction>
            <securityTitle>
                <value>Common Stock</value>
            </securityTitle>
            <transactionDate>
                <value>2025-12-12</value>
            </transactionDate>
            <transactionCoding>
                <transactionFormType>4</transactionFormType>
                <transactionCode>A</transactionCode>
                <equitySwapInvolved>0</equitySwapInvolved>
            </transactionCoding>
            <transactionAmounts>
                <transactionShares>
                    <value>4932</value>
                    <footnoteId id="F1"/>
                </transactionShares>
                <transactionPricePerShare>
                    <value>0</value>
                </transactionPricePerShare>
                <transactionAcquiredDisposedCode>
                    <value>A</value>
                </transactionAcquiredDisposedCode>
            </transactionAmounts>
            <postTransactionAmounts>
                <sharesOwnedFollowingTransaction>
                    <value>4932</value>
                </sharesOwnedFollowingTransaction>
            </postTransactionAmounts>
            <ownershipNature>
                <directOrIndirectOwnership>
                    <value>D</value>
                </directOrIndirectOwnership>
            </ownershipNature>
        </nonDerivativeTransaction>
    </nonDerivativeTable>

    <footnotes>
        <footnote id="F1">Represents restricted stock units (&quot;RSUs&quot;), each one of which represents the contingent right to receive one share of the Issuer's common stock. The RSUs will vest annually in three substantially equal installments on each of the first three anniversaries of the grant date, subject to the Reporting Person's continued service with the Issuer.</footnote>
    </footnotes>

    <remarks>This Form 4 is being filed late due to unanticipated delays in receiving the Reporting Person's EDGAR codes, which delays we understand were due to the high volume of applications at the time.</remarks>

    <ownerSignature>
        <signatureName>/s/ Julie Szeker, attorney-in-fact</signatureName>
        <signatureDate>2025-12-30</signatureDate>
    </ownerSignature>
</ownershipDocument>
