Provider Demographics
NPI:1619993672
Name:UROLOGY CENTER OF SOUTHWEST LOUISIANA INC
Entity Type:Organization
Organization Name:UROLOGY CENTER OF SOUTHWEST LOUISIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:VERHEECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-433-5282
Mailing Address - Street 1:234 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5960
Mailing Address - Country:US
Mailing Address - Phone:337-433-5282
Mailing Address - Fax:337-433-1159
Practice Address - Street 1:234 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5960
Practice Address - Country:US
Practice Address - Phone:337-433-5282
Practice Address - Fax:337-433-1159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1795411Medicaid
LA760760185OtherUNITED HEALTHCARE
LA7607601850OtherBLUE CROSS BLUE SHIELD
LACP2688OtherRAILROAD MEDICARE
LA760760185OtherUNITED HEALTHCARE
LA1795411Medicaid