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NPI Code Detail

MEDICARE: LSUHSC FAMILY PRACTICE CENTER @ LCMH

MEDICARE: LSUHSC FAMILY PRACTICE CENTER @ LCMH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073514493
Entity Type Code : Organization
Provider Name (Legal Business Name) : LSUHSC FAMILY PRACTICE CENTER @ LCMH
Provider Business Mailing Address
First Line : PO BOX 123453, DEPT 3453
Second Line :
City : DALLAS
State : TX
Zip : 75312-0001
Country : US
Telephone Number : 337-494-2921
Fax Number : 337-494-6523
Provider Business Practice Location Address
First Line : 1525 OAK PARK BLVD
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70601-8849
Country : US
Telephone Number : 337-494-6767
Fax Number : 337-494-6750
Authorized Official
Title or Position : CFO
Name : DAWN JOHNSON-HATCHER
Credential :
Telephone Number : 337-494-2094
Provider Enumeration Date : 08/09/2005
Last Update Date : 12/04/2023

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Directions to “LSUHSC FAMILY PRACTICE CENTER @ LCMH ” Practice Location

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