Provider Demographics
NPI:1386790426
Name:CLAMPETT, PATRICIA ROSE
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ROSE
Last Name:CLAMPETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIGHTHOUSE
Other - Middle Name:MEDICAL
Other - Last Name:EQUIPMENT LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:120 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06787-1746
Mailing Address - Country:US
Mailing Address - Phone:860-283-6248
Mailing Address - Fax:860-283-6247
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:CT
Practice Address - Zip Code:06787-1746
Practice Address - Country:US
Practice Address - Phone:860-283-6248
Practice Address - Fax:860-283-6247
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171W00000XOther Service ProvidersContractor
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004266658Medicaid