Provider Demographics
NPI:1699717231
Name:LAKE CHARLES MEDICAL SERVICES, INC
Entity type:Organization
Organization Name:LAKE CHARLES MEDICAL SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:USHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-494-3200
Mailing Address - Street 1:1717 OAK PARK BLVD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8991
Mailing Address - Country:US
Mailing Address - Phone:337-494-6799
Mailing Address - Fax:337-430-6950
Practice Address - Street 1:1717 OAK PARK BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8991
Practice Address - Country:US
Practice Address - Phone:337-494-6799
Practice Address - Fax:337-430-6950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-11
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1944408Medicaid
LA1944408Medicaid