Basic Information
| Provider Information | |||||||||
| NPI: | 1457786253 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIGHTHOUSE MEDICAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 E. PLEASANT VALLEY BLVD. | ||||||||
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| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149431271 | ||||||||
| FaxNumber: | 8149408516 | ||||||||
| Practice Location | |||||||||
| Address1: | 507 TIRE HILL RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159057311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142544410 | ||||||||
| FaxNumber: | 8142544348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2013 | ||||||||
| LastUpdateDate: | 02/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8149431271 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | MD044867E | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.