Provider Demographics
NPI:1114011244
Name:LAKE CHARLES MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:LAKE CHARLES MEDICAL SERVICES, INC
Other - Org Name:REHABILITATION INSTITUTE OF SOUTHWEST LA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V. P. OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:USHER
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:337-494-3202
Mailing Address - Street 1:1717 OAK PARK BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8990
Mailing Address - Country:US
Mailing Address - Phone:337-494-6868
Mailing Address - Fax:337-494-6869
Practice Address - Street 1:1701 OAK PARK BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8911
Practice Address - Country:US
Practice Address - Phone:337-494-6868
Practice Address - Fax:337-494-6869
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA06-00010375OtherOCCUPATIONAL LICENSE
LADN5736OtherRR MEDICARE
LANH6455OtherBCBS
LA5CW24Medicare PIN