Provider Demographics
NPI:1598048787
Name:LIGHTHOUSE MEDICAL, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE MEDICAL, LLC
Other - Org Name:CENTRAL PA PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-793-4833
Mailing Address - Street 1:601 N FRONT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-2303
Mailing Address - Country:US
Mailing Address - Phone:814-342-2333
Mailing Address - Fax:814-342-2277
Practice Address - Street 1:601 N FRONT ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-2303
Practice Address - Country:US
Practice Address - Phone:814-342-2333
Practice Address - Fax:814-342-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMC438515208100000X
PAMD044867E208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020712560001Medicaid
PA1020712560001Medicaid