Provider Demographics
NPI:1043493810
Name:LIGHTHOUSE ANESTHESIOLOGY OF SOUTH CAROLINA, PA
Entity Type:Organization
Organization Name:LIGHTHOUSE ANESTHESIOLOGY OF SOUTH CAROLINA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-819-4478
Mailing Address - Street 1:PO BOX 3012
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3012
Mailing Address - Country:US
Mailing Address - Phone:866-480-2246
Mailing Address - Fax:770-237-1124
Practice Address - Street 1:420 W WESMARK BLVD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1983
Practice Address - Country:US
Practice Address - Phone:803-905-5590
Practice Address - Fax:770-237-1124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIGHTHOUSE ANESTHESIOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty