Provider Demographics
NPI:1932315215
Name:LIGHTHOUSE PEDIATRICS
Entity type:Organization
Organization Name:LIGHTHOUSE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGURNJAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-388-3993
Mailing Address - Street 1:925 TOMMY MUNRO DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2134
Mailing Address - Country:US
Mailing Address - Phone:228-388-3993
Mailing Address - Fax:228-385-9941
Practice Address - Street 1:925 TOMMY MUNRO DR
Practice Address - Street 2:SUITE A
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2134
Practice Address - Country:US
Practice Address - Phone:228-388-3993
Practice Address - Fax:228-385-9941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03500512Medicaid