Provider Demographics
NPI:1699789529
Name:ST. LUKE'S DIAGNOSTIC CLINIC OF LAKE CHARLES, L.L.C.
Entity type:Organization
Organization Name:ST. LUKE'S DIAGNOSTIC CLINIC OF LAKE CHARLES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BARRILLEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-439-2000
Mailing Address - Street 1:643 S RYAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5726
Mailing Address - Country:US
Mailing Address - Phone:337-439-2000
Mailing Address - Fax:337-439-2025
Practice Address - Street 1:643 S RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5726
Practice Address - Country:US
Practice Address - Phone:337-439-2000
Practice Address - Fax:337-439-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017896261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty