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NPI Code Detail

MEDICARE: THE GENERAL MEDICINE CLINIC, LLC

MEDICARE: THE GENERAL MEDICINE CLINIC, LLC
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
1207P00000XEmergency Medicine Physician
2208D00000XGeneral Practice 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 : 1073985396
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE GENERAL MEDICINE CLINIC, LLC
Provider Business Mailing Address
First Line : 3608 KIRKMAN ST
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70607-3006
Country : US
Telephone Number : 337-602-6302
Fax Number :
Provider Business Practice Location Address
First Line : 3608 KIRKMAN ST
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70607-3006
Country : US
Telephone Number : 337-602-6302
Fax Number : 337-594-0931
Authorized Official
Title or Position : CEO
Name : JANICE F LOWE-RODRIGUEZ
Credential :
Telephone Number : 337-602-6302
Provider Enumeration Date : 10/26/2015
Last Update Date : 05/19/2016

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Directions to “THE GENERAL MEDICINE CLINIC, LLC ” Practice Location

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