1811060866 NPI number — LAKE CHARLES MEDICAL SERVICES, INC

Table of content: (NPI 1811060866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811060866 NPI number — LAKE CHARLES MEDICAL SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKE CHARLES MEDICAL SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHARLES B. WOODARD, M.D., CARDIOVASCULAR DISEASES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811060866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 1ST AVE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70601-8884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-439-1737
Provider Business Mailing Address Fax Number:
337-439-4990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-8884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-439-1737
Provider Business Practice Location Address Fax Number:
337-439-4990
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
USHER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CHIEF OPERATIONS OFFICER
Authorized Official Telephone Number:
337-494-3202

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  012245 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NG4865 . This is a "BCBS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 06-00004568 . This is a "OCCUPATIONAL LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: CH1901 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1944408 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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