Provider Demographics
NPI:1235281239
Name:SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION INC
Entity Type:Organization
Organization Name:SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION INC
Other - Org Name:FAMILY MEDICAL CLINIC OF SWLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-494-2094
Mailing Address - Street 1:PO BOX 122539, DEPT 2539
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-0001
Mailing Address - Country:US
Mailing Address - Phone:337-480-5550
Mailing Address - Fax:337-480-5568
Practice Address - Street 1:1890 W GAUTHIER RD STE 155
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-7119
Practice Address - Country:US
Practice Address - Phone:337-480-5550
Practice Address - Fax:337-480-5568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CB49Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER