Provider Demographics
NPI:1144915083
Name:LIGHTHOUSE PEDIATRICS
Entity type:Organization
Organization Name:LIGHTHOUSE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NESMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-327-1800
Mailing Address - Street 1:1000 W STATE HIGHWAY 6 STE 500
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3790
Mailing Address - Country:US
Mailing Address - Phone:254-327-1800
Mailing Address - Fax:254-343-1326
Practice Address - Street 1:1000 W STATE HIGHWAY 6 STE 500
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-3790
Practice Address - Country:US
Practice Address - Phone:254-327-1800
Practice Address - Fax:254-343-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty