Provider Demographics
NPI:1487979670
Name:LIGHTHOUSE MEDICAL, LLC
Entity type:Organization
Organization Name:LIGHTHOUSE MEDICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-793-4833
Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-1825
Mailing Address - Country:US
Mailing Address - Phone:814-682-7022
Mailing Address - Fax:814-682-7089
Practice Address - Street 1:200 HOSPITAL DR STE 6
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1825
Practice Address - Country:US
Practice Address - Phone:814-682-7088
Practice Address - Fax:814-682-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044867E261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain