Healthcare Provider Details

I. General information

NPI: 1881737104
Provider Name (Legal Business Name): CARDIOTHORACIC SURGEONS OF THE SOUTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 FOSTER ST
LAKE CHARLES LA
70601-5815
US

IV. Provider business mailing address

PO BOX 3084
LAKE CHARLES LA
70602-3084
US

V. Phone/Fax

Practice location:
  • Phone: 337-439-5800
  • Fax: 337-439-0003
Mailing address:
  • Phone: 337-436-7560
  • Fax: 337-433-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number15365R
License Number StateLA

VIII. Authorized Official

Name: DR. XAVIER RENE MOUSSET
Title or Position: OWNER
Credential: MD
Phone: 337-439-5800