1972605384 NPI number — SWLA CENTER FOR HEALTH SERVICES

Table of content: (NPI 1972605384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972605384 NPI number — SWLA CENTER FOR HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWLA CENTER FOR HEALTH SERVICES
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:
SWLA CENTER FOR HEALTH SERVICES PHARMACY
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:
1972605384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 OPELOUSAS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70601-2641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-493-5144
Provider Business Mailing Address Fax Number:
337-944-9020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 OPELOUSAS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-2641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-493-5144
Provider Business Practice Location Address Fax Number:
337-944-9020
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOUBERT
Authorized Official First Name:
FRANCESCA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY DIRECTOR
Authorized Official Telephone Number:
337-493-5144

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY.005697-IR , 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: 1234435 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2035419 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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