Provider Demographics
NPI:1932700085
Name:LIGHTHOUSE SURGICAL SUITES, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE SURGICAL SUITES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYDEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-600-6175
Mailing Address - Street 1:2 MARKET PL STE 100
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-5921
Mailing Address - Country:US
Mailing Address - Phone:603-600-6175
Mailing Address - Fax:603-600-6388
Practice Address - Street 1:2 MARKET PL STE 100
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NH
Practice Address - Zip Code:03049-5921
Practice Address - Country:US
Practice Address - Phone:603-724-1638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical