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General NPI Number Information
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NPI Number | 1811060866
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Entity Type | Organization
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Legal Business Name | LAKE CHARLES MEDICAL SERVICES, INC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 2800 1ST AVE SUITE C
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8884
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Country | US
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Telephone | 337-439-1737
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Fax | 337-439-4990
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Provider Business Mailing Address
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Address Line | 2800 1ST AVE SUITE C
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8884
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Country | US
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Telephone | 337-439-1737
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Fax | 337-439-4990
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MR. DAVID B USHER
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Credential | COO
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Telephone | 337-494-3202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 012245
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License Number State | LA
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