Healthcare Provider Details

I. General information

NPI: 1578607693
Provider Name (Legal Business Name): THE ARTHRITIS CENTER OF SOUTHWEST LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 BAYOU PINES EAST DR SUITE B
LAKE CHARLES LA
70601-7198
US

IV. Provider business mailing address

PO BOX 3006
LAKE CHARLES LA
70602-3006
US

V. Phone/Fax

Practice location:
  • Phone: 337-493-7000
  • Fax: 337-493-7001
Mailing address:
  • Phone: 337-436-7560
  • Fax: 337-433-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number24079
License Number StateLA

VIII. Authorized Official

Name: DR. ENRIQUE ANTONIO MENDEZ
Title or Position: OWNER
Credential: MD
Phone: 337-493-7000