Healthcare Provider Details

I. General information

NPI: 1356448138
Provider Name (Legal Business Name): JANE SMECK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 COUNTRY CLUB RD
LAKE CHARLES LA
70605-5203
US

IV. Provider business mailing address

1905 COUNTRY CLUB RD
LAKE CHARLES LA
70605-5203
US

V. Phone/Fax

Practice location:
  • Phone: 337-990-8000
  • Fax: 337-990-8010
Mailing address:
  • Phone: 337-990-8000
  • Fax: 337-990-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG0132
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.206723
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: