MEDICARE: DIABETES EDUCATION OF LAKE CHARLES MEMORIAL HOSPITAL

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
1	282N00000X	General Acute Care Hospital	2210	LA

General Provider Information

NPI Number	:	1497084073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETES EDUCATION OF LAKE CHARLES MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	1801 OAK PARK BLVD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 OAK PARK BLVD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8900
Country	:	US
Telephone Number	:	337-494-6425
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	DAWN JOHNSON
Credential	:
Telephone Number	:	337-494-2094

Provider Enumeration Date	:	12/10/2009
Last Update Date	:	12/04/2023

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