Provider Demographics
NPI:1558305862
Name:LAKE CHARLES MEDICAL SERVICES
Entity Type:Organization
Organization Name:LAKE CHARLES MEDICAL SERVICES
Other - Org Name:NEUROSURGICAL INSTITUTE OF LAKE CHARLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:USHER
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:337-494-3202
Mailing Address - Street 1:1717 OAK PARK BLVD
Mailing Address - Street 2:SECOND AVE
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8990
Mailing Address - Country:US
Mailing Address - Phone:337-494-4720
Mailing Address - Fax:337-494-4721
Practice Address - Street 1:1717 OAK PARK BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8990
Practice Address - Country:US
Practice Address - Phone:337-494-4720
Practice Address - Fax:337-494-4721
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0600010034207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA9900888Medicaid
LACG9701OtherRAILROAD MEDICARE
LA5CU76Medicare PIN