Healthcare Provider Details

I. General information

NPI: 1881948669
Provider Name (Legal Business Name): LIGHTHOUSE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N FRONT ST SUITE B
PHILIPSBURG PA
16866-2303
US

IV. Provider business mailing address

300 E WALNUT AVE
ALTOONA PA
16601-5210
US

V. Phone/Fax

Practice location:
  • Phone: 814-342-2333
  • Fax: 814-940-8516
Mailing address:
  • Phone: 814-943-1272
  • Fax: 814-940-8516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD044867E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD044867E
License Number StatePA

VIII. Authorized Official

Name: SARAH B STEELE
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 814-943-1272