Provider Demographics
NPI:1407168032
Name:LCMS SURGICAL ASSOCIATES OF SOUTHWEST LOUSIANA, LLC
Entity Type:Organization
Organization Name:LCMS SURGICAL ASSOCIATES OF SOUTHWEST LOUSIANA, LLC
Other - Org Name:SURGICAL ASSOCIATES OF SOUTHWEST LOUISIANA
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-HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-494-2094
Mailing Address - Street 1:PO BOX 122342, DEPT 2342
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:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:2770 3RD AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8994
Practice Address - Country:US
Practice Address - Phone:337-494-4868
Practice Address - Fax:337-494-4870
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE CHARLES MEDICAL SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-12
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10-00013733208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA10-00013733OtherOCCUPATIONAL LICENSE