Organization
LIGHTHOUSE HEALTH PLAN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT METHENY (CFO)
(850) 908-3001
Entity
Organization
Contact information
Practice address
700 E GREGORY ST, PENSACOLA, FL 32502-4142
(850) 908-3001
Mailing address
700 E GREGORY ST, PENSACOLA, FL 32502-4142
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1001225-01
—
FL
05
—
1001225-02
—
FL
Enumeration date
10/12/2018
Last updated
10/12/2018
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