MEDICARE: CHRISTUS HEALTH SOUTHWESTERN LOUISIANA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1000X	Student Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043472202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTUS HEALTH SOUTHWESTERN LOUISIANA

Provider Business Mailing Address
First Line	:	524 DR MICHAEL DEBAKEY DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-5725
Country	:	US
Telephone Number	:	337-217-4540
Fax Number	:	337-439-5029

Provider Business Practice Location Address
First Line	:	2802 PINEVIEW ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70615-2063
Country	:	US
Telephone Number	:	337-217-4540
Fax Number	:	337-439-5029

Authorized Official
Title or Position	:	CEO
Name	:	MR. PAUL TREVINO
Credential	:
Telephone Number	:	337-491-7730

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	07/05/2022

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Directions to “CHRISTUS HEALTH SOUTHWESTERN LOUISIANA ” Practice Location

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