| Lighthouse Family Medicine | |
|
6515 Colleyville Blvd Colleyville TX 76034-6231 | |
| (817) 424-3774 | |
| (817) 424-3398 |
| Full Name | Lighthouse Family Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 6515 Colleyville Blvd, Colleyville, Texas |
| Authorized Official Name and Position | Kenneth Douglas Lecroy (OWNER) |
| Authorized Official Contact | 8174243774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Family Medicine 6515 Colleyville Blvd Colleyville TX 76034-6231 Ph: (817) 424-3774 | Lighthouse Family Medicine 6515 Colleyville Blvd Colleyville TX 76034-6231 Ph: (817) 424-3774 |
| NPI Number | 1851599690 |
|---|---|
| Provider Enumeration Date | 07/03/2007 |
| Last Update Date | 10/08/2020 |
| Medicare PECOS PAC ID | 2961666052 |
|---|---|
| Medicare Enrollment ID | O20120621000567 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851599690 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Texas) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | K2736 (Texas) | Primary |
| Provider Name | Kenneth Douglas Lecroy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598848830 PECOS PAC ID: 1658547344 Enrollment ID: I20120629000381 |
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