Provider Demographics
NPI:1467739789
Name:LC INTERNAL MEDICINE CLINIC LLC
Entity Type:Organization
Organization Name:LC INTERNAL MEDICINE CLINIC LLC
Other - Org Name:LC INTERNAL MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LALITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALASANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-405-4076
Mailing Address - Street 1:8110 SUMMA AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3419
Mailing Address - Country:US
Mailing Address - Phone:225-200-7428
Mailing Address - Fax:225-666-9999
Practice Address - Street 1:384 FULWAR SKIPWITH RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-5705
Practice Address - Country:US
Practice Address - Phone:225-590-8006
Practice Address - Fax:225-666-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12672R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2345583Medicaid
LA1544507Medicaid