Lighthouse Medical LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

MD044867E Issued in PA

Legal business name

LIGHTHOUSE MEDICAL LLC

Practice address

253 Easterly Pkwy
Suite 1
State College, PA 16801-6301

Phone

(814) 308-8456

Fax

(814) 308-8728

NPI assigned

Aug 5, 2011

Organization subpart

No

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

Authorized official

Name

John H. Johnson, MD

Title

Ceo/Owner

Phone

(814) 943-1271

Specialties & licenses 3

Addresses

Other identifiers 1

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

{
    "created_epoch": "1312502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488240000000",
    "number": "1831478049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 E. PLEASANT VALLEY BLVD.",
            "city": "ALTOONA",
            "state": "PA",
            "postal_code": "16602",
            "telephone_number": "814-943-1271",
            "fax_number": "814-940-8516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "253 EASTERLY PKWY",
            "address_2": "SUITE 1",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168016301",
            "telephone_number": "814-308-8456",
            "fax_number": "814-308-8728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-05",
        "last_updated": "2017-02-28",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "814-943-1271",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "PA",
            "license": "MD044867E",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "PA",
            "license": "MD438515",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "PA",
            "license": "OS015480",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1020712560001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine (Anesthesiology) Physician in State College, PA
• Providers in State College, PA by specialty
• Pain Medicine (Anesthesiology) Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; 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.