Healthcare Provider Details

I. General information

NPI: 1154335958
Provider Name (Legal Business Name): LAKE CHARLES MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 3RD AVE STE 350
LAKE CHARLES LA
70601-0404
US

IV. Provider business mailing address

2770 3RD AVE STE 350
LAKE CHARLES LA
70601-0404
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-2921
  • Fax: 337-494-6523
Mailing address:
  • Phone: 337-494-2921
  • Fax: 337-494-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DAWN JOHNSON-HATCHER
Title or Position: CFO
Credential:
Phone: 337-494-2094