Provider Demographics
NPI:1326630385
Name:LIGHTHOUSE MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MULDOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-247-4800
Mailing Address - Street 1:1442 IRVINE BLVD STE 136
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3870
Mailing Address - Country:US
Mailing Address - Phone:949-751-8548
Mailing Address - Fax:657-247-4806
Practice Address - Street 1:1442 IRVINE BLVD STE 136
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3870
Practice Address - Country:US
Practice Address - Phone:949-751-8548
Practice Address - Fax:657-247-4806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies