Lighthouse Medical Supply, LLC

Primary specialty

Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X

Legal business name

LIGHTHOUSE MEDICAL SUPPLY, LLC

Practice address

245 Long Hill Rd
Middletown, CT 06457-4063

Phone

(866) 633-0005

Fax

(860) 343-8111

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Barry E O'Dougherty

Title

Authorized Official - President

Phone

(203) 575-1401

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amie Madru, RPT

  • Physical Therapist
  • Middletwon, CT
  • NPI 1972712107
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679650907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 LONG HILL RD",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064574063",
            "telephone_number": "866-633-0005",
            "fax_number": "860-343-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 LONG HILL RD",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064574063",
            "telephone_number": "866-633-0005",
            "fax_number": "860-343-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE MEDICAL SUPPLY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "O'DOUGHERTY",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL - PRESIDENT",
        "authorized_official_telephone_number": "203-575-1401",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brett J Lieberman, N.D.
• Nikolai Lieders, MD
• Life Changes, LLC
• Lifted, LLC
• Valerie Light, LPC
• Laura Liistro, LCSW
• Jaimie Lindberg
• Ryan Willis Lindemann
• Matthew Listo, M.D.
• Laura Ann Litwin, ATC, LAT

• Parenteral & Enteral Nutrition Supplies (DME) in Middletown, CT
• Providers in Middletown, CT by specialty
• Parenteral & Enteral Nutrition Supplies (DME) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.