Healthcare Provider Details

I. General information

NPI: 1083711006
Provider Name (Legal Business Name): CARDIOVASCULAR SPECIALISTS OF SOUTHWEST LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5727
US

IV. Provider business mailing address

600 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5727
US

V. Phone/Fax

Practice location:
  • Phone: 337-493-4345
  • Fax: 337-493-4355
Mailing address:
  • Phone: 337-493-4345
  • Fax: 337-493-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTNE HINTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 337-493-4345