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General NPI Number Information
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NPI Number | 1699789529
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Entity Type | Organization
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Legal Business Name | ST. LUKE'S DIAGNOSTIC CLINIC OF LAKE CHARLES, L.L.C.
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 643 S RYAN ST
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5726
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Country | US
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Telephone | 337-439-2000
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Fax | 337-439-2025
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Provider Business Mailing Address
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Address Line | 643 S RYAN ST
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5726
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Country | US
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Telephone | 337-439-2000
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Fax | 337-439-2025
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRYAN P BARRILLEAUX
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Credential | M.D.
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Telephone | 337-439-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 017896
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License Number State | LA
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