Provider Demographics
NPI:1174025001
Name:LIGHTHOUSE POINT SURGERY CENTER LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE POINT SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAMDIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-685-5955
Mailing Address - Street 1:1821 NE 25TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7744
Mailing Address - Country:US
Mailing Address - Phone:954-941-0484
Mailing Address - Fax:954-941-0485
Practice Address - Street 1:1821 NE 25TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7744
Practice Address - Country:US
Practice Address - Phone:954-941-0484
Practice Address - Fax:954-941-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty