Healthcare Provider Details

I. General information

NPI: 1043493810
Provider Name (Legal Business Name): LIGHTHOUSE ANESTHESIOLOGY OF SOUTH CAROLINA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W WESMARK BLVD
SUMTER SC
29150-1983
US

IV. Provider business mailing address

PO BOX 3012
ST AUGUSTINE FL
32085-3012
US

V. Phone/Fax

Practice location:
  • Phone: 803-905-5590
  • Fax: 770-237-1124
Mailing address:
  • Phone: 866-480-2246
  • Fax: 770-237-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN J DOYLE
Title or Position: PRESIDENT
Credential: MD
Phone: 904-819-4478