Provider Demographics
NPI:1841547809
Name:LIGHTHOUSE MEDICAL LLC
Entity type:Organization
Organization Name:LIGHTHOUSE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR OF BILLING
Authorized Official - Phone:814-793-4833
Mailing Address - Street 1:300 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-5210
Mailing Address - Country:US
Mailing Address - Phone:814-943-1272
Mailing Address - Fax:814-940-8516
Practice Address - Street 1:217 GLENN ST
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2460
Practice Address - Country:US
Practice Address - Phone:301-722-7246
Practice Address - Fax:301-777-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0073183332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies