Healthcare Provider Details

I. General information

NPI: 1639218407
Provider Name (Legal Business Name): LAKE CHARLES MEDICAL SERVICES ORTHOPEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 OAK PARK BLVD
LAKE CHARLES LA
70601-8991
US

IV. Provider business mailing address

1717 OAK PARK BLVD
LAKE CHARLES LA
70601-8991
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-4900
  • Fax: 337-494-4936
Mailing address:
  • Phone: 337-494-4900
  • Fax: 337-494-4936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID B USHER
Title or Position: SR. V.P. BUSINESS DEVELOPMENT
Credential: FACHE
Phone: 337-494-3200