MEDICARE: MCNEESE STATE UNIVERSITY

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1851616262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCNEESE STATE UNIVERSITY

Provider Business Mailing Address
First Line	:	BOX 91895
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70609-1895
Country	:	US
Telephone Number	:	337-475-5457
Fax Number	:

Provider Business Practice Location Address
First Line	:	4205 RYAN STREET
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70609
Country	:	US
Telephone Number	:	337-475-5457
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT OF BUSINESS AFFAIRS
Name	:	MR. EDDIE MECHE
Credential	:
Telephone Number	:	337-475-5501

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	03/30/2010

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Directions to “MCNEESE STATE UNIVERSITY ” Practice Location

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