=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376725952
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWLA CENTER FOR HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2007
-----------------------------------------------------
Last Update Date | 03/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 PATTERSON ST
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70501-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-769-9451
-----------------------------------------------------
Fax | 337-769-9460
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 OPELOUSAS STREET
-----------------------------------------------------
City | LAKE CHARLES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-439-9983
-----------------------------------------------------
Fax | 337-497-2556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | JAMYA A MOUTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 337-769-9451
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------