Provider Demographics
NPI:1588997423
Name:LIGHTHOUSE HEALTHCARE, LLC
Entity type:Organization
Organization Name:LIGHTHOUSE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGINE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:AUGUSTUS
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA
Authorized Official - Phone:405-737-2465
Mailing Address - Street 1:6300 NW EXPRESSWAY STE 120
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5128
Mailing Address - Country:US
Mailing Address - Phone:405-445-3697
Mailing Address - Fax:405-212-5571
Practice Address - Street 1:1211 N SHARTEL AVE STE 900
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2477
Practice Address - Country:US
Practice Address - Phone:405-235-5331
Practice Address - Fax:405-235-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center