Provider Demographics
NPI:1154456507
Name:HEALTH ASSOCIATES OF LAKE CHARLES
Entity type:Organization
Organization Name:HEALTH ASSOCIATES OF LAKE CHARLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-491-9880
Mailing Address - Street 1:2800 1ST AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8884
Mailing Address - Country:US
Mailing Address - Phone:337-491-9880
Mailing Address - Fax:337-433-3268
Practice Address - Street 1:2800 1ST AVE STE A
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8884
Practice Address - Country:US
Practice Address - Phone:337-491-9880
Practice Address - Fax:337-433-3268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAS3413135261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1598765067OtherNPI
LA1952301319OtherNPI
LA1508866963OtherNPI