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General NPI Number Information
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NPI Number | 1407808405
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Entity Type | Organization
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Legal Business Name | LAKE CHARLES MEMORIAL HEART AND VASCULAR CENTER
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 1717 OAK PARK BLVD FL 2
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8990
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Country | US
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Telephone | 337-494-3278
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Fax | 337-494-3240
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Provider Business Mailing Address
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Address Line | PO BOX 122152, DEPT 2152 DEPT 2152
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City | DALLAS
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State | TX
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Zip | 75312-2152
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Country | US
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Telephone | 337-494-2921
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Fax | 337-494-6523
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Authorized Official
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Title or Position | CFO
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Name | DAWN JOHNSON-HATCHER
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Credential |
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Telephone | 337-494-2094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | LA
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