MEDICARE: LGH SURGICAL CLINIC

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	208600000X	Surgery Physician		LA

Other Identifiers

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

General Provider Information

NPI Number	:	1629016191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LGH SURGICAL CLINIC

Provider Business Mailing Address
First Line	:	411 E VAUGHN AVE
Second Line	:	SUITE 200
City	:	RUSTON
State	:	LA
Zip	:	71270-5972
Country	:	US
Telephone Number	:	318-255-1212
Fax Number	:	318-513-1599

Provider Business Practice Location Address
First Line	:	411 E VAUGHN AVE
Second Line	:	SUITE 200
City	:	RUSTON
State	:	LA
Zip	:	71270-5972
Country	:	US
Telephone Number	:	318-255-1212
Fax Number	:	318-513-1599

Authorized Official
Title or Position	:	CEO
Name	:	MR. THOMAS J STONE
Credential	:
Telephone Number	:	318-254-2450

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	08/22/2020

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Directions to “LGH SURGICAL CLINIC ” Practice Location

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