Healthcare Provider Details

I. General information

NPI: 1548207772
Provider Name (Legal Business Name): W O MOSS REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WALTERS ST
LAKE CHARLES LA
70607-4647
US

IV. Provider business mailing address

1000 WALTERS ST
LAKE CHARLES LA
70607-4647
US

V. Phone/Fax

Practice location:
  • Phone: 337-475-8100
  • Fax: 337-475-8104
Mailing address:
  • Phone: 337-475-8100
  • Fax: 337-475-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL K BUTLER
Title or Position: ACTING CEO
Credential: M.D.
Phone: 225-922-0775