Lighthouse Labs LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

45D2095694 Issued in TX

Legal business name

LIGHTHOUSE LABS LLC

Practice address

1735 Keller Springs Rd Ste 202
Carrollton, TX 75006-3006

Phone

(972) 242-5388

NPI assigned

May 29, 2015

Last updated

Jun 20, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jason Bourque

Title

Owner

Phone

(972) 242-5388

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1114306636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1735 KELLER SPRINGS RD",
            "address_2": "STE 202",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750062962",
            "telephone_number": "972-242-5388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1735 KELLER SPRINGS RD STE 202",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750063006",
            "telephone_number": "972-242-5388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE LABS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-29",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "BOURQUE",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-242-5388"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TX",
            "license": "45D2095694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Carrollton, TX
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.