Healthcare Provider Details

I. General information

NPI: 1003902677
Provider Name (Legal Business Name): LIGHTHOUSE DIAGNOSTIC IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8683 E LINCOLN AVENUE SUITE 100
LONE TREE CO
80124
US

IV. Provider business mailing address

8683 E LINCOLN AVENUE SUITE 100
LONE TREE CO
80124
US

V. Phone/Fax

Practice location:
  • Phone: 303-706-1555
  • Fax: 303-706-1199
Mailing address:
  • Phone: 303-706-1555
  • Fax: 303-706-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number95802
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number95802
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number95802
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number95802
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License Number95802
License Number StateCO
# 6
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number95802
License Number StateCO

VIII. Authorized Official

Name: SHEILA B RACZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 303-790-6515