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General NPI Number Information
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NPI Number | 1801184007
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Entity Type | Organization
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Legal Business Name | LCMS EAR, NOSE AND THROAT CLINIC OF SOUTHWEST LOUISIANA, LLC
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 1890 W GAUTHIER RD STE 205
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City | LAKE CHARLES
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State | LA
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Zip | 70605-7179
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Country | US
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Telephone | 337-480-5595
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Fax | 337-480-5596
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Provider Business Mailing Address
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Address Line | PO BOX 123057 DEPT 3057
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City | DALLAS
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State | TX
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Zip | 75312-3057
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Country | US
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Telephone | 337-480-5595
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Fax | 337-480-5596
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Authorized Official
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Title or Position | CFO
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Name | CHARLES WHITSON
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Credential |
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Telephone | 337-494-3204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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