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General NPI Number Information
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NPI Number | 1598048787
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE MEDICAL, LLC
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/25/2011
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Provider Practice Location Address
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Address Line | 601 N FRONT ST SUITE A
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City | PHILIPSBURG
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State | PA
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Zip | 16866-2303
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Country | US
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Telephone | 814-342-2333
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Fax | 814-342-2277
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Provider Business Mailing Address
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Address Line | 601 N FRONT ST SUITE A
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City | PHILIPSBURG
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State | PA
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Zip | 16866-2303
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Country | US
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Telephone | 814-342-2333
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Fax | 814-342-2277
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | SARAH B STEELE
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Credential |
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Telephone | 814-793-4833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MC438515
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | MD044867E
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License Number State | PA
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