Provider Demographics
NPI:1003902677
Name:LIGHTHOUSE DIAGNOSTIC IMAGING LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE DIAGNOSTIC IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:B
Authorized Official - Last Name:RACZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-790-6515
Mailing Address - Street 1:8683 E LINCOLN AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:303-706-1555
Mailing Address - Fax:303-706-1199
Practice Address - Street 1:8683 E LINCOLN AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-706-1555
Practice Address - Fax:303-706-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO958022471B0102X, 2471C3401X, 2471C3402X, 2471M1202X, 2471M2300X, 2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Single Specialty
Not Answered2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Single Specialty
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
Not Answered2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Not Answered2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Single Specialty
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66080240Medicaid
CO66080240Medicaid