Provider Demographics
NPI:1205040995
Name:CHRISTUS HEALTH SOUTHWESTERN LOUISIANA
Entity Type:Organization
Organization Name:CHRISTUS HEALTH SOUTHWESTERN LOUISIANA
Other - Org Name:MOLO MIDDLE SBHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-899-8191
Mailing Address - Street 1:524 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5725
Mailing Address - Country:US
Mailing Address - Phone:337-437-3977
Mailing Address - Fax:337-437-8203
Practice Address - Street 1:2300 MEDORA ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-1204
Practice Address - Country:US
Practice Address - Phone:337-437-3977
Practice Address - Fax:337-437-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1447161Medicaid