Executive Medical Clinic Of Lake Charles
Family Medicine in Lake Charles, LA. Organization (NPI-2).
NPI number1982126520
StatusActive
Last updated in NPPESSep 19, 2022
Details
- NPI
- 1982126520
- Entity type
- Organization (NPI-2)
- Legal business name
- Executive Medical Clinic Of Lake Charles
- Organization subpart
- No
- Enumeration date
- Jul 14, 2017
- Certification date
- Sep 14, 2022
- Last updated
- Sep 19, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | AP06496 | LA | Yes |
Practice location
765 East Bayou Pines DriveLake Charles, LA 70601-5690
Phone 337-210-1260
Mailing address
765 East Bayou Pines DriveLake Charles, LA 70601-5690
Phone 337-210-1260
Authorized official
Melissa Lebrun
President
2259390050
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