MEDICARE: LIGHTHOUSE FAMILY MEDICINE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4174	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821040999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE FAMILY MEDICINE, INC

Provider Business Mailing Address
First Line	:	3061 N LAZY EIGHT CT
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-4319
Country	:	US
Telephone Number	:	907-376-5337
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 N WILLOW ST
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7042
Country	:	US
Telephone Number	:	907-376-5337
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	ELIZABETH C. TURGEON
Credential	:	M.D.
Telephone Number	:	907-376-5337

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	03/27/2014

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