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General NPI Number Information
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NPI Number | 1831478049
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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 | 08/05/2011
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 253 EASTERLY PKWY SUITE 1
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City | STATE COLLEGE
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State | PA
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Zip | 16801-6301
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Country | US
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Telephone | 814-308-8456
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Fax | 814-308-8728
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Provider Business Mailing Address
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Address Line | 311 E. PLEASANT VALLEY BLVD.
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City | ALTOONA
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State | PA
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Zip | 16602
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Country | US
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Telephone | 814-943-1271
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Fax | 814-940-8516
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Authorized Official
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Title or Position | CEO/OWNER
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Name | JOHN H. JOHNSON
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Credential | MD
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Telephone | 814-943-1271
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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 | MD438515
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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 | OS015480
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | MD044867E
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License Number State | PA
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