Provider Demographics
NPI:1407157381
Name:LCMS J WILLIAM GROVES, MD, LLC
Entity Type:Organization
Organization Name:LCMS J WILLIAM GROVES, MD, LLC
Other - Org Name:J WILLIAM GROVES MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. V.P. OF PHYSICIAN AND SPECIALIT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELAHOUSSAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-494-3208
Mailing Address - Street 1:PO BOX 2267
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-2267
Mailing Address - Country:US
Mailing Address - Phone:337-480-5530
Mailing Address - Fax:337-480-5531
Practice Address - Street 1:1890 W GAUTHIER RD STE 130
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-7179
Practice Address - Country:US
Practice Address - Phone:337-480-5530
Practice Address - Fax:337-480-5531
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE CHARLES MEDICAL SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-09
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty