Provider Demographics
NPI:1821040999
Name:LIGHTHOUSE FAMILY MEDICINE, INC
Entity Type:Organization
Organization Name:LIGHTHOUSE FAMILY MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:TURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-376-5337
Mailing Address - Street 1:3061 N LAZY EIGHT CT
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-4319
Mailing Address - Country:US
Mailing Address - Phone:907-376-5337
Mailing Address - Fax:
Practice Address - Street 1:290 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7042
Practice Address - Country:US
Practice Address - Phone:907-376-5337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG415Medicaid
AKMD06704Medicaid
AKK160684Medicare PIN