Provider Demographics
NPI:1659764967
Name:CALCASIEU CAMERON HOSPITAL MEDICINE GROUP LLC
Entity Type:Organization
Organization Name:CALCASIEU CAMERON HOSPITAL MEDICINE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PROVOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-534-0952
Mailing Address - Street 1:PO BOX 721191
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4908
Mailing Address - Country:US
Mailing Address - Phone:405-240-9381
Mailing Address - Fax:405-341-9217
Practice Address - Street 1:701 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5053
Practice Address - Country:US
Practice Address - Phone:337-527-7034
Practice Address - Fax:337-534-0953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LADV5356OtherRR MEDICARE
LA2385887Medicaid