NPIMap

Organization Active NPI

Lighthouse Physician Services, PLLC

  • Diagnostic Radiology Physician
  • Montgomery, TX
National Provider Identifier
1770866444
Registry record updated Sep 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
N9353 Issued in TX
Legal business name
LIGHTHOUSE PHYSICIAN SERVICES, PLLC
Practice address
427 Trace Way Dr
Montgomery, TX 77316-6852
Phone
(936) 463-8777
Fax
(603) 658-0484
NPI assigned
Sep 20, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2011

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

Authorized official

Name
Dr. Lesly Benodin, M.D.
Title
Radiologist
Phone
(603) 252-7447

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X N9353 TX Primary

Addresses

Primary practice location

427 Trace Way Dr
Montgomery, TX 77316-6852

Mailing address

427 Trace Way Dr
Montgomery, TX 77316-6852
Phone (936) 463-8777

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316476800000",
    "number": "1770866444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 TRACE WAY DR",
            "city": "MONTGOMERY",
            "state": "TX",
            "postal_code": "773166852",
            "telephone_number": "936-463-8777",
            "fax_number": "603-658-0484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 TRACE WAY DR",
            "city": "MONTGOMERY",
            "state": "TX",
            "postal_code": "773166852",
            "telephone_number": "936-463-8777",
            "fax_number": "603-658-0484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE PHYSICIAN SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-20",
        "last_updated": "2011-09-20",
        "status": "A",
        "authorized_official_last_name": "BENODIN",
        "authorized_official_first_name": "LESLY",
        "authorized_official_title_or_position": "RADIOLOGIST",
        "authorized_official_telephone_number": "603-252-7447",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "N9353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; 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.