Healthcare Provider Details

I. General information

NPI: 1386790426
Provider Name (Legal Business Name): PATRICIA ROSE CLAMPETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIGHTHOUSE MEDICAL EQUIPMENT LLC

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MAIN ST
THOMASTON CT
06787-1746
US

IV. Provider business mailing address

120 S MAIN ST
THOMASTON CT
06787-1746
US

V. Phone/Fax

Practice location:
  • Phone: 860-283-6248
  • Fax: 860-283-6247
Mailing address:
  • Phone: 860-283-6248
  • Fax: 860-283-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: