Provider Demographics
NPI:1821700113
Name:LIGHTBEARERS SOCIETY
Entity Type:Organization
Organization Name:LIGHTBEARERS SOCIETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:202-744-5124
Mailing Address - Street 1:2203 TWIN OAKS DR APT 67
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-2972
Mailing Address - Country:US
Mailing Address - Phone:202-744-5124
Mailing Address - Fax:
Practice Address - Street 1:11086 STRANG LINE RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2113
Practice Address - Country:US
Practice Address - Phone:202-744-5124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical MicrobiologyGroup - Multi-Specialty