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General NPI Number Information
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NPI Number | 1407281546
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Entity Type | Organization
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Legal Business Name | COMMUNITY MEDICAL GROUP-ST CHARLES INC
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 02/17/2014
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Provider Practice Location Address
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Address Line | 1057 PAUL MAILLARD RD SUITE2250
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City | LULING
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State | LA
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Zip | 70070-4349
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Country | US
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Telephone | 985-785-2218
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Fax | 985-785-7753
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Provider Business Mailing Address
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Address Line | 503 MCMILLAN RD
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City | WEST MONROE
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State | LA
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Zip | 71291-5327
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Country | US
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Telephone | 318-329-4700
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN W MCDANIEL
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Credential |
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Telephone | 504-522-2014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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