Provider Demographics
NPI:1447515176
Name:FOUR LIGHTS HEALTH CARE CONSULTING LLC
Entity type:Organization
Organization Name:FOUR LIGHTS HEALTH CARE CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-376-6825
Mailing Address - Street 1:1601 LAFAYETTE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1032
Mailing Address - Country:US
Mailing Address - Phone:765-362-8211
Mailing Address - Fax:765-362-8212
Practice Address - Street 1:1601 LAFAYETTE RD STE 200
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1032
Practice Address - Country:US
Practice Address - Phone:765-362-8211
Practice Address - Fax:765-362-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040702A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF53136Medicare UPIN